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Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients.
Technol Health Care. 2016 Nov 14; 24(6):899-907.TH

Abstract

BACKGROUND

Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV).

OBJECTIVE

We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes.

METHODS

All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors.

RESULTS

Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group.

CONCLUSIONS

Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany. Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France.Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Marburg, Germany.Center for Hereditary Tumors at the Surgical Center, HELIOS Klinikum Wuppertal, University Witten/Herdecke, Wuppertal, Germany.Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany. Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France.Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany.Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany.Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany. Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Kreisklinikum, Siegen, Germany.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27434283

Citation

Kratz, Thomas, et al. "Implementation and Effects of Pulse-contour- Automated SVV/CI Guided Goal Directed Fluid Therapy Algorithm for the Routine Management of Pancreatic Surgery Patients." Technology and Health Care : Official Journal of the European Society for Engineering and Medicine, vol. 24, no. 6, 2016, pp. 899-907.
Kratz T, Simon C, Fendrich V, et al. Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients. Technol Health Care. 2016;24(6):899-907.
Kratz, T., Simon, C., Fendrich, V., Schneider, R., Wulf, H., Kratz, C., Efe, T., Schüttler, K. F., & Zoremba, M. (2016). Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients. Technology and Health Care : Official Journal of the European Society for Engineering and Medicine, 24(6), 899-907.
Kratz T, et al. Implementation and Effects of Pulse-contour- Automated SVV/CI Guided Goal Directed Fluid Therapy Algorithm for the Routine Management of Pancreatic Surgery Patients. Technol Health Care. 2016 Nov 14;24(6):899-907. PubMed PMID: 27434283.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients. AU - Kratz,Thomas, AU - Simon,Christina, AU - Fendrich,Volker, AU - Schneider,Ralph, AU - Wulf,Hinnerk, AU - Kratz,Caroline, AU - Efe,Turgay, AU - Schüttler,Karl F, AU - Zoremba,Martin, PY - 2016/7/20/pubmed PY - 2017/5/16/medline PY - 2016/7/20/entrez KW - Goal directed therapy KW - fluid therapy KW - major abdominal surgery KW - pancreatic surgery KW - pluse-contour-automated-analysis SP - 899 EP - 907 JF - Technology and health care : official journal of the European Society for Engineering and Medicine JO - Technol Health Care VL - 24 IS - 6 N2 - BACKGROUND: Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). OBJECTIVE: We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes. METHODS: All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors. RESULTS: Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group. CONCLUSIONS: Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery. SN - 1878-7401 UR - https://www.unboundmedicine.com/medline/citation/27434283/Implementation_and_effects_of_pulse_contour__automated_SVV/CI_guided_goal_directed_fluid_therapy_algorithm_for_the_routine_management_of_pancreatic_surgery_patients_ L2 - https://content.iospress.com/openurl?genre=article&id=doi:10.3233/THC-161237 DB - PRIME DP - Unbound Medicine ER -