2 research outputs found
Continuous cardiac index trending (ProAQT) via a radial arterial line versus standard care in general surgical patients
Introduction
Several single-center studies and meta-analyses have shown that perioperative
goal-directed therapy may significantly improve outcomes in general surgical
patients. We hypothesized that using a treatment algorithm based on pulse
pressure variation, cardiac index trending by radial artery pulse contour
analysis, and mean arterial pressure in a study group, would result in reduced
complications, reduced length of hospital stay and quicker return of bowel
movement postoperatively in abdominal surgical patients, when compared to a
control group.
Methods
160 patients undergoing elective major abdominal surgery were randomized to
the Study Group (79 patients) or to the Control Group (81 patients). In the
Study Group hemodynamic therapy was guided by pulse pressure variation,
cardiac index trending and mean arterial pressure. In the Control Group
hemodynamic therapy was performed at the discretion of the treating
anesthesiologist. Outcome data were recorded up to 28 days postoperatively.
Results
The total number of complications was significantly lower in the Study Group
(72 vs. 52 complications, p = 0.038). In particular, infectious complications
were significantly reduced (Study Group: 13 vs. Control Group: 26
complications, p = 0.023). There were no significant differences between the
two groups for return of bowel movement (Study Group: 3 vs. Control Group: 2
days postoperatively, p = 0.316), duration of post anesthesia care unit stay (Study Group: 180 vs. Control Group: 180 minutes, p = 0.516) or length of
hospital stay (Study Group: 11 vs. Control Group: 10 days, p = 0.929).
Conclusions
This multi-center study demonstrates that hemodynamic goal-directed therapy
using pulse pressure variation, cardiac index trending and mean arterial
pressure as the key parameters leads to a decrease in postoperative
complications in patients undergoing major abdominal surgery
Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study
IntroductionSeveral single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).Methods160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.ResultsThe total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).ConclusionsThis multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.Trial registrationClinicalTrial.gov, NCT01401283