Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery

Joosten, Alexandre; Coeckelenbergh, Sean; Delaporte, Amélie; Ickx, Brigitte; Closset, Jean; Roumeguère, Thierry; Barvais, Luc; Obbergh, Luc Van; Rinehart, Joseph; Linden, Philippe Van der

doi:10.1097/eja.0000000000000827

Cited by 47 publications

(26 citation statements)

References 26 publications

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“…We have demonstrated that implementation of this "computer system" resulted in less intraoperative time spent in a preload-dependent state (stroke volume variation > 13%) compared to a manually applied protocol, using both minimally invasive and noninvasive technologies [43,44]. Implementation of these systems at the patient's bedside has also been associated with better patient outcomes compared to routine care [45]. The software for this technology has now been implemented into the EV1000 monitoring device as a real-time clinical decision support system and is widely available for clinical use [46].…”

Section: Yesmentioning

confidence: 97%

Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review

et al. 2020

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Background: Perioperative fluid managementincluding the type, dose, and timing of administration-directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate. Main text: The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flowrelated variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more "controlled" context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications.

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Section: Yesmentioning

confidence: 97%

Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review

et al. 2020

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“…There are no guidelines concerning perioperative fluid therapy for patients with end-stage renal failure (ESRF) [1]. Nearly all the studies of perioperative fluid therapy excluded patients with ESRF because of their physical condition [1][2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Goal-Directed Fluid Therapy Monitored by Pulse-Pressure Variation Using a C ontinuous Non-Invasive Arterial Pressure Monitoring System (the CNAPTM System) During Parathyroidectomy in Patients with End-Stage Renal Failure - A randomized trial

Song

Liu

Jiang

et al. 2019

Preprint

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Background: There are no well-recognized guidelines for intraoperative fluid management in patients with end-stage renal failure (ESRF) . Goal-directed fluid therapy (GDFT) is a concept of perioperative fluid management that improves patients’ prognosis. Dynamic indicators better predict fluid response than static indicators. Aim: In this study, we assessed a GDFT protocol with monitoring of pulse pressure variation (PPV) in patients with ESRF undergoing parathyroidectomy. Methods: The study included 102 patients who underwent elective parathyroidectomy. They were randomized to a control group (restrictive group, n = 51) that was managed with a restricted fluid regimen or a PPV group (GDFT group, n = 51) that was given a normal saline infusion and was monitored for change in PPV during the intraoperative period. If PPV reached >13%, 250 mL normal saline was administered over 15 min. Ephedrine was given at increments of 6 mg to keep mean arterial pressure >65 mmHg . Hemodynamic variables in the perioperative period were recorded. The primary endpoint was the occurrence of postoperative hypotension. Results: The occurrence of postoperative hypotension in the GDFT group was lower than in the restrictive group (0 vs. 11.67%, P = 0.027). The patients with complications in the GDFT group was lower than in the restrictive group (35.3% vs. 54.9%, P = 0.047). The volume of saline infused during the intraoperative period was 364 (219-408) mL in the GDFT group and 50 (50-50) mL in the restrictive group ( P = 0.001). Ephedrine was given to 16/51 (29.4%) of the GDFT group and 27/51 (52.9%) of the restrictive group ( P = 0.027). Conclusion: The use of goal-directed fluid therapy with the dynamic PPV indicator in patients with ESRF undergoing parathyroidectomy guides the administration of infused fluids, with reduced incidence of postoperative hypotension.

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“…Although it only takes into account the fluid component of GDHT (i.e. preload optimization), it increases protocol compliance and was associated with improved outcome when compared to fluid therapy based on a static parameters of fluid responsiveness[78]. In addition, when compared to manual goal-directed fluid therapy, this system maintains patients in a preload independent state for a longer period of time[81,82].…”

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confidence: 99%

Perioperative Goal-Directed Hemodynamic Therapy: From Invasive Monitoring To Automated Physiological Closed-Loop Systems

Coeckelenbergh

Zaouter

Alexander

et al. 2019

Preprint

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Perioperative goal-directed hemodynamic therapy (GDHT) has evolved from invasive “supra-physiological” maximization of oxygen delivery into minimally and non-invasively guided automated stroke volume optimization. Throughout this evolution, investigators have simultaneously developed novel monitors, updated strategies, and automated technologies to aid them in GDHT implementation. In particular, closed-loop systems have been created to both increase GDHT compliance and decrease physician workload. Currently, these automated systems offer an elegant approach to help the clinician optimize cardiac output and end-organ perfusion during the perioperative period. Most notably, automated fluid optimization guided by dynamic parameters of fluid responsiveness has shown its feasibility, safety, and impact. Making the leap into fully automated GDHT has been accomplished on a small scale, but there are considerable challenges that must be surpassed before integrating all hemodynamic components into an automated system during general anesthesia. In this review we will discuss the potential future of automated GDHT by covering the key events that paved the way from initially complex and time consuming approaches to simple yet effective hands-free strategies.

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Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery

Abstract: NCT02978430.

Cited by 47 publications

References 26 publications

Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review

Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review

Efficacy of Goal-Directed Fluid Therapy Monitored by Pulse-Pressure Variation Using a C ontinuous Non-Invasive Arterial Pressure Monitoring System (the CNAPTM System) During Parathyroidectomy in Patients with End-Stage Renal Failure - A randomized trial

Perioperative Goal-Directed Hemodynamic Therapy: From Invasive Monitoring To Automated Physiological Closed-Loop Systems

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