Personalized Versus Protocolized Fluid Management Using Noninvasive Hemodynamic Monitoring (Clearsight System) in Patients Undergoing Moderate-Risk Abdominal Surgery

Joosten, Alexandre; Lawrence, Shalini Raj; Colesnicenco, Alexandra; Coeckelenbergh, Sean; Vincent, Jean‐Louis; Linden, Philippe Van der; Rinehart, Joseph

doi:10.1213/ane.0000000000003553

Cited by 36 publications

(45 citation statements)

References 15 publications

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“…The total sample size was <100 participants for 33 studies (Bahlmann et al, 2019;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Cecconi et al, 2011;Colantonio et al, 2015;El Sharkawy et al, 2013;Funk et al, 2015;Han et al, 2016;Jammer et al, 2015;Joosten et al, 2019;Kaufmann et al, 2018;Kim et al, 2018;Kumar et al, 2016;Lobo et al, 2000;Mayer et al, 2010;Mikor et al, 2015;Mythen & Webb, 1995;Peng et al, 2014;Reisinger et al, 2017;Scheeren et al, 2013;Senagore et al, 2009;Shoemaker et al, 1988;Sinclair et al, 1997;Ueno et al, 1998;Van der Linden et al, 2010;Venn et al, 2002;Weinberg et al, 2017;Weinberg et al, 2019;Wu et al, 2017;Yin et al, 2018;Zakhaleva et al, 2013;Zeng et al, 2014;Zhang et al, 2013) (50%) and the majority (77%) were conducted in a single centre setting (Bartha et al, 2013;Bender et al, 1997;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Boyd et al, 1993;Cecconi et al, 2011;…”

Section: Resultsmentioning

confidence: 99%

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

et al. 2020

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Background Perioperative goal-directed haemodynamic therapy (GDHT), defined as the administration of fluids with or without inotropes or vasoactive agents against explicit measured goals to augment blood flow, has been evaluated in many randomised controlled trials (RCTs) over the past four decades. Reported post-operative pulmonary complications commonly include chest infection or pneumonia, atelectasis, acute respiratory distress syndrome or acute lung injury, aspiration pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the substantial clinical literature in this area, it remains unclear whether their incidence is reduced by GDHT. This systematic review aims to determine the effect of GDHT on the respiratory outcomes listed above, in surgical patients. Methods We searched the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical trial registries up until January 2020. We included all RCTs reporting pulmonary outcomes. The primary outcome was post-operative pulmonary complications and secondary outcomes were specific pulmonary complications and intra-operative fluid input. Data synthesis was performed on Review Manager and heterogeneity was assessed using I2 statistics. Results We identified 66 studies with 9548 participants reporting pulmonary complications. GDHT resulted in a significant reduction in total pulmonary complications (OR 0.74, 95% CI 0.59 to 0.92). The incidence of pulmonary infections, reported in 45 studies with 6969 participants, was significantly lower in the GDHT group (OR 0.72, CI 0.60 to 0.86). Pulmonary oedema was recorded in 23 studies with 3205 participants and was less common in the GDHT group (OR 0.47, CI 0.30 to 0.73). There were no differences in the incidences of pulmonary embolism or acute respiratory distress syndrome. Sub-group analyses demonstrated: (i) benefit from GDHT in general/abdominal/mixed and cardiothoracic surgery but not in orthopaedic or vascular surgery; and (ii) benefit from fluids with inotropes and/or vasopressors in combination but not from fluids alone. Overall, the GDHT group received more colloid (+280 ml) and less crystalloid (−375 ml) solutions than the control group. Due to clinical and statistical heterogeneity, we downgraded this evidence to moderate. Conclusions This systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate. PROSPERO registry reference: CRD42020170361

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Section: Resultsmentioning

confidence: 99%

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

et al. 2020

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“…Partial CO 2 rebreathing Partial CO 2 rebreathing is a non-invasive technique that estimates CO by using respiratory gas analysis and pulse oximetry. Many studies suggest moderate to good agreement with CO measurements obtained by the thermodilution method during surgery and in ICU mechanically ventilated patients [84][85][86][87], but there was a great bias during a period of rapidly changing shunt and dead space, as occurs at the start of one-lung ventilation [88]. Although many studies have shown that CO was underestimated by the partial CO 2 rebreathing method compared with the thermodilution method, it still can be used to guide haemodynamic management during surgery [87,89].…”

Section: Volume Clamp and Radial Artery Applanation Tonometrymentioning

confidence: 99%

Contemporary perioperative haemodynamic monitoring

Pang

Hendrickx

Liu

et al. 2019

ait

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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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Personalized Versus Protocolized Fluid Management Using Noninvasive Hemodynamic Monitoring (Clearsight System) in Patients Undergoing Moderate-Risk Abdominal Surgery

Cited by 36 publications

References 15 publications

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

Contemporary perioperative haemodynamic monitoring

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

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