Terapia hemodinámica guiada por objetivos basada en parámetros de flujo con Doppler esofágico: revisión sistemática, metaanálisis y análisis secuencial de ensayos

Ripollés‐Melchor, Javier; Francés, R. Casans; Espinosa, Á.; Gurumeta, Alfredo Abad; Feldheiser, Aarne; López‐Timoneda, F.; Vecino, J.M. Calvo

doi:10.1016/j.redar.2015.07.009

Cited by 14 publications

(1 citation statement)

References 99 publications

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“…Esophageal Doppler (ED) is a noninvasive, inexpensive and easy 4 hemodynamic monitoring system, with high validity and clinical concordance, 5 that allows continuous estimation of corrected flow time, stroke volume, and cardiac output 1 during surgery, facilitating optimized real-time fluid resuscitation, and output management. 3 The pulmonary artery catheter has been deemed too invasive for the types of surgery being undertaken.…”

Section: Introductionmentioning

confidence: 99%

The usefulness of the transesophageal Doppler in the anesthetic management of Morgagni hernia repair - A case report

Babo¹,

Monteiro²,

Santos³

et al. 2021

APIC

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Morgagni hernia in adults is a rare condition and is associated with complications such as recurrent chest infections, respiratory failure and cardiac tamponade. Its correction represents an anesthetic challenge. Intraoperative esophageal Doppler provides important information in real time about the patient’s cardiac function and vascular filling, aiding in decision making by the anesthesiologist. We report a case of a 70–year–old woman, ASA Physical Status–III, and presented with chest pain, dyspnea and hypoxemia. Her chest x-ray revealed opacification of 2/3 of the left hemithorax and 1/2 of the right. Computed tomography confirmed a bilateral Morgagni hernia. The patient underwent immediate corrective surgery. Intraoperative cardiovascular function was monitored with esophageal Doppler. Compression and decompression of thoracic structures produces enormous hemodynamic and respiratory impact. After herniated contents removal it showed an increase in systolic volume and cardiac index and a correction of flow time. Transient arterial hypotension was verified, requiring fluid therapy and vasopressor support. Diaphragmatic defect was corrected and general hemodynamic stabilization was achieved. Patient was discharged asymptomatic. The esophageal Doppler was important in this case because it allowed us to measure fundamental hemodynamic variables in real time, such as cardiac index or systolic volume, and to subsequently act accordingly. Key words: Esophageal; Doppler; Morgagni hernia; Anesthesia Citation: Babo NM, Monteiro MT, Santos AB, Carreira CR. The usefulness of the transesophageal Doppler in the anesthetic management of Morgagni hernia repair - A case report. Anaesth pain intensive care 2021;25(2):206-211. DOI: 10.35975/apic.v25i2.1467 Received: 19 November 2020, Reviewed: 22 December 2020, Accepted: 12 January 2021

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Section: Introductionmentioning

confidence: 99%

The usefulness of the transesophageal Doppler in the anesthetic management of Morgagni hernia repair - A case report

Babo¹,

Monteiro²,

Santos³

et al. 2021

APIC

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Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery

Wrzosek

Jakowicka-Wordliczek²,

Zajączkowska

et al. 2019

Cochrane Database of Systematic Reviews

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Meta-analysis of goal-directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

2020

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We read with great interest the metaanalysis published by Rollins and colleagues 1 . The study found no benefit for oesophageal Doppler monitoring (ODM) versus conventional fluid management in patients undergoing abdominal surgery, and was methodologically well performed.However, the study selection raises concerns that impact the result substantially. The included study by Brandstrup et al. 2 compares a perioperative zerobalance group with intraoperative ODM. The study found no differences between the groups. However, zerobalance therapy has to be considered as intervention-based, given specialized beds being able to determine patient weight without mobilization, which was associated with a higher perioperative workload versus the ODM. The study was considered a success for ODM, and therefore should not be included in a meta-analysis comparing ODM with conventional care.Furthermore, the most influential study regarding ODM by Calvo-Vecino and co-workers 3 , with 420 patients, was not included in the analysis. This would have increased the sample size by 37⋅7 per cent. The study was performed as a multicentre RCT within an enhanced recovery after surgery pathway in patients undergoing abdominal surgery, and showed a reduction in postoperative morbidity, especially surgical-site infection (SSI).Consequently, the meta-analysis should be modified by exclusion of the study by Brandstrup and colleagues 2 and inclusion of that by . As the Brandstrup study has significant weight and the Calvo-Vecino study is the largest to date, a reduction in morbidity and SSI is the most likely effect of correcting the meta-analysis. With that modification, the meta-analysis would be consistent with the actual literature and previously published meta-analyses on the topic 4,5 . DisclosureThe authors declare no conflict of interest.

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Terapia hemodinámica guiada por objetivos basada en parámetros de flujo con Doppler esofágico: revisión sistemática, metaanálisis y análisis secuencial de ensayos

Cited by 14 publications

References 99 publications

The usefulness of the transesophageal Doppler in the anesthetic management of Morgagni hernia repair - A case report

The usefulness of the transesophageal Doppler in the anesthetic management of Morgagni hernia repair - A case report

Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery

Meta-analysis of goal-directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

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