J Clin Monit Comput - Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study.

Tópicos

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Resumo

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.

Resumo Limpo

periop hemodynam optimis improv postop outcom patient undergo highrisk surgeri hrs prospect random multicentr studi studi effect individu goaldirect fluid manag base continu stroke volum variat svv stroke volum sv monitor postop outcom patient undergo hrs random either control group con n goaldirect group gdt n gdt svv sv continu monitor flotracvigileo patient brought maintain plateau frankstarl curv svv sv increas respons fluid load organ dysfunct assess use sofa score resourc util use tiss score patient follow day postop complic main outcom measur number complic infecti cardiac respiratori renal hematolog abdomin postop complic maximum sofa score cumul tiss score icu stay durat mechan ventil length icu stay time fit discharg patient exclud final analysi group surgeri gdt receiv colloid con vs ml p svv decreas gdt p con number postop wound infect lower gdt vs p although statist signific proport patient least one complic vs number postop complic per patient vs maximum sofa score vs cumul tiss score vs tend lower multicentr studi show fluid manag base svv sv optimis protocol feasibl decreas postop wound infect find also suggest goaldirect strategi might decreas postop organ dysfunct

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