Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Forst, Maik von der; Weiterer, Sebastian; Dietrich, Maximilian; Loos, Martin; Lichtenstern, Christoph; Weigand, Markus A.; Siegler, Benedikt Hermann

doi:10.1007/s00101-020-00867-7

Cited by 9 publications

(3 citation statements)

References 145 publications

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“…Excessive intraoperative fluid balance was correlated with a higher mortality. Similar findings were observed in several other studies that have also associated higher fluid balance with worse outcomes and have carefully considered fluid management in surgical patients [ 20 – 22 ]. Something that caught our attention was that the same volume of synthetic colloid solutions was administered in both cohorts.…”

Section: Discussionsupporting

confidence: 90%

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

Gomes,

Lobo,

Sá Malbouisson

et al. 2023

PLoS ONE

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Introduction In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart. Methods The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards. Results After matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1–29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0–2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36–4.20) and hospital stay (HR = 1.64, 95% CI: 1.03–2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01–1.06), higher creatinine (OR = 1.31, 95% CI 1.1–1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35–4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95–0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery. Conclusion In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.

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Section: Discussionsupporting

confidence: 90%

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

Gomes,

Lobo,

Sá Malbouisson

et al. 2023

PLoS ONE

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“…As far as intraoperative and postoperative management is concerned, fluid therapy and vasoactive drugs during interventions have been shown to play a pivotal role in these patients' outcomes (49). In order to improve intraoperative management, in the last few years the concept of Goal-Directed Therapy has progressively emerged (5,13,14,16), and is also applied to vascular surgical patients (50,51). For this purpose, hemodynamic monitoring is necessary, for which several devices have been developed (17,18).…”

Section: Discussionmentioning

confidence: 99%

“…Hemodynamic monitoring is crucial in critically ill patients (1)(2)(3) as well as during and after major surgery (1,4,(5)(6)(7), in order to promptly detect the occurrence of acute alterations, such as shock, that could lead to hypoperfusion and organ ischemia, and to evaluate the effects of pharmacological interventions.…”

Section: Introductionmentioning

confidence: 99%

The Use of Pressure Recording Analytical Method in Patients Undergoing Endovascular Repair for Abdominal Aortic Aneurysm: The Impact on Clinical Decisions for the Appropriate Postoperative Setting and Cost-effective Analysis

Giacomelli,

Dorigo,

Romano

et al. 2024

ama

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Objective. To analyze the use of the Pressure Recording Analytical Method (PRAM), an hemodynamic monitoring system, in evaluating intraoperative and postoperative hemodynamic instability in patients undergoing endovascular repair for abdominal aortic aneurysm, and to evaluate if the decision to refer patients to a ordinary ward or to a Cardiac Step-Down Unit (CSDU) after the intervention on the basis of intraoperative hemodynamic monitoring could be more cost-effective. Materials and Methods. After preoperative clinical evaluation, 44 patients were divided in this non-randomised study into two groups accord- ing to their postoperative destination: Group 1-ward (N=22) and Group 2-CSDU (N=22). All patients underwent monitoring with PRAM during the intervention and in the 24 postoperative hours, measuring several indices of myocardial contractility and other hemodynamic variables. Results. According to the variability of two parameters, Stroke Volume Variation and Pulse Pressure Variation, patients were classified as stable or unstable. Unstable patients showed a significant alteration in several hemodynamic indices, in comparison to stable ones. According to the intraoperative monitoring, eight high risk patients could have been sent to an ordinary ward due to their stability, with a reduction in the improper use of CSDU and, consequently, in costs. Conclusions. Hemodynamic monitoring with PRAM can be useful in these patients, both for intraoperative management and for the choice of the more appropriate postoperative setting, possibly reducing the improper use of CSDU for hemodynami- cally stable patients who are judged to be at high risk preoperatively, and re-evaluating low surgical risk patients with an unstable intraoperative pattern, with a possible reduction in costs.

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Intensivtherapie bei Ileus und toxischem Megakolon

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2022

Die Intensivmedizin

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Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Cited by 9 publications

References 145 publications

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

The Use of Pressure Recording Analytical Method in Patients Undergoing Endovascular Repair for Abdominal Aortic Aneurysm: The Impact on Clinical Decisions for the Appropriate Postoperative Setting and Cost-effective Analysis

Intensivtherapie bei Ileus und toxischem Megakolon

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