Tags

Type your tag names separated by a space and hit enter

Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study.
J Clin Monit Comput. 2013 Jun; 27(3):225-33.JC

Abstract

Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10 % and SV increase <10 % in response to fluid loading). Organ dysfunction was assessed using the SOFA score and resource utilization using the TISS score. Patients were followed up to 28 days for postoperative complications. Main outcome measures were the number of complications (infectious, cardiac, respiratory, renal, hematologic and abdominal post-operative complications), maximum SOFA score and cumulative TISS score during ICU stay, duration of mechanical ventilation, length of ICU stay, and time until fit for discharge. 12 patients had to be excluded from final analysis (6 in each group). During surgery, GDT received more colloids than CON (1,589 vs. 927 ml, P < 0.05) and SVV decreased in GDT (from 9.0 to 8.0 %, P < 0.05) but not in CON. The number of postoperative wound infections was lower in GDT (0 vs. 7, P < 0.01). Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction.

Authors+Show Affiliations

Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. t.w.l.scheeren@umcg.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23558909

Citation

Scheeren, Thomas W L., et al. "Goal-directed Intraoperative Fluid Therapy Guided By Stroke Volume and Its Variation in High-risk Surgical Patients: a Prospective Randomized Multicentre Study." Journal of Clinical Monitoring and Computing, vol. 27, no. 3, 2013, pp. 225-33.
Scheeren TW, Wiesenack C, Gerlach H, et al. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput. 2013;27(3):225-33.
Scheeren, T. W., Wiesenack, C., Gerlach, H., & Marx, G. (2013). Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. Journal of Clinical Monitoring and Computing, 27(3), 225-33. https://doi.org/10.1007/s10877-013-9461-6
Scheeren TW, et al. Goal-directed Intraoperative Fluid Therapy Guided By Stroke Volume and Its Variation in High-risk Surgical Patients: a Prospective Randomized Multicentre Study. J Clin Monit Comput. 2013;27(3):225-33. PubMed PMID: 23558909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. AU - Scheeren,Thomas W L, AU - Wiesenack,Christoph, AU - Gerlach,Herwig, AU - Marx,Gernot, Y1 - 2013/04/05/ PY - 2012/11/02/received PY - 2013/03/25/accepted PY - 2013/4/6/entrez PY - 2013/4/6/pubmed PY - 2014/1/7/medline SP - 225 EP - 33 JF - Journal of clinical monitoring and computing JO - J Clin Monit Comput VL - 27 IS - 3 N2 - Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10 % and SV increase <10 % in response to fluid loading). Organ dysfunction was assessed using the SOFA score and resource utilization using the TISS score. Patients were followed up to 28 days for postoperative complications. Main outcome measures were the number of complications (infectious, cardiac, respiratory, renal, hematologic and abdominal post-operative complications), maximum SOFA score and cumulative TISS score during ICU stay, duration of mechanical ventilation, length of ICU stay, and time until fit for discharge. 12 patients had to be excluded from final analysis (6 in each group). During surgery, GDT received more colloids than CON (1,589 vs. 927 ml, P < 0.05) and SVV decreased in GDT (from 9.0 to 8.0 %, P < 0.05) but not in CON. The number of postoperative wound infections was lower in GDT (0 vs. 7, P < 0.01). Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction. SN - 1573-2614 UR - https://www.unboundmedicine.com/medline/citation/23558909/Goal_directed_intraoperative_fluid_therapy_guided_by_stroke_volume_and_its_variation_in_high_risk_surgical_patients:_a_prospective_randomized_multicentre_study_ L2 - https://doi.org/10.1007/s10877-013-9461-6 DB - PRIME DP - Unbound Medicine ER -