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Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial.
Br J Anaesth. 2017 Jun 01; 118(6):852-861.BJ

Abstract

Background

Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial.

Methods

One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment.

Results

Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min - 1 m - 2 ]; P < 0.001) and stroke volume index (43 vs. 34 [ml m 2 ]; P < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P = 0.005).

Conclusions

Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay.

Clinical trial registration.

The study was registered in the German Clinical Trials Register (DRKS 00006961). https://drks-neu.uniklinik-freiburg.de/drks_web/.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care.Department of Anaesthesiology and Critical Care.IMBI, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany.Department of Anaesthesiology and Critical Care.Department of Thoracic Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany.IMBI, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany.Department of Anaesthesiology and Critical Care.Department of Anaesthesiology and Critical Care.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28575331

Citation

Kaufmann, K B., et al. "Oesophageal Doppler Guided Goal-directed Haemodynamic Therapy in Thoracic Surgery - a Single Centre Randomized Parallel-arm Trial." British Journal of Anaesthesia, vol. 118, no. 6, 2017, pp. 852-861.
Kaufmann KB, Stein L, Bogatyreva L, et al. Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial. Br J Anaesth. 2017;118(6):852-861.
Kaufmann, K. B., Stein, L., Bogatyreva, L., Ulbrich, F., Kaifi, J. T., Hauschke, D., Loop, T., & Goebel, U. (2017). Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial. British Journal of Anaesthesia, 118(6), 852-861. https://doi.org/10.1093/bja/aew447
Kaufmann KB, et al. Oesophageal Doppler Guided Goal-directed Haemodynamic Therapy in Thoracic Surgery - a Single Centre Randomized Parallel-arm Trial. Br J Anaesth. 2017 Jun 1;118(6):852-861. PubMed PMID: 28575331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial. AU - Kaufmann,K B, AU - Stein,L, AU - Bogatyreva,L, AU - Ulbrich,F, AU - Kaifi,J T, AU - Hauschke,D, AU - Loop,T, AU - Goebel,U, PY - 2016/12/11/accepted PY - 2017/6/3/entrez PY - 2017/6/3/pubmed PY - 2018/12/12/medline KW - hemodynamics KW - postoperative complications KW - thoracic surgery SP - 852 EP - 861 JF - British journal of anaesthesia JO - Br J Anaesth VL - 118 IS - 6 N2 - Background: Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial. Methods: One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment. Results: Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min - 1 m - 2 ]; P < 0.001) and stroke volume index (43 vs. 34 [ml m 2 ]; P < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P = 0.005). Conclusions: Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay. Clinical trial registration.: The study was registered in the German Clinical Trials Register (DRKS 00006961). https://drks-neu.uniklinik-freiburg.de/drks_web/. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/28575331/Oesophageal_Doppler_guided_goal_directed_haemodynamic_therapy_in_thoracic_surgery___a_single_centre_randomized_parallel_arm_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)30049-1 DB - PRIME DP - Unbound Medicine ER -