Zielgerichtete Volumentherapie durch Optimierung von Schlagvolumen (variation) bei Hochrisikoeingriffen:eine randomisierte kontrollierte Multicenter Pilotstudie

Abstract

Subject: Perioperative hemodynamic optimization reduces the incidence of postoperative complications in patients after high-risk interventions. We investigated the influence of a targeted, individualized intraoperative volume therapy, based on measurements of stroke volume variation (SVV) and stroke volume (SV), on the postoperative patient outcome. Material, Methods: 52 high-risk patients (ASA 3 or 4) were treated with the consent of the respective ethics committee randomized either to a control group (group K, n = 26) or a targeted therapy group (group T, n = 26). Patients with cardiac arrhythmias or a tidal volume <7 ml / kg under mechanical ventilation were excluded. SVV and SV were measured continuously (FloTrac / Vigileo, Edwards Lifesciences, Irvine, USA). Patients of the therapie group received colloidal fluid (200 ml 6% HAES130 / 0.4) until a plateau is reached on the Frank-Starling curve (SVV <10% and SV increase <10% after volume release). On the intensive care unit organ dysfunction (SOFA score) and therapy intensity (TISS score) detected. Patients were postoperative over a period of 28 days is observed. Results: Both groups were similar in terms of ASA status, comorbidity, type and duration of the procedure (275 vs. 280 min), heart rate, blood pressure, and CVP to OP start. However, patients in group T were younger than in group K (68 vs. 73 years, p <0.05). Intraoperatively, patients of the therapy group received more colloids (1589 vs. 927 ml, p <0.05) and the SVV decreased significantly in the therapy group (from 9.0 to 8.0%, p <0.05), but not in the control group. The number of postoperative wound infections was also significantly lower in the therapy group (0 vs. 7, p <0.01). In addition, 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) were also lower in the therapy group. Conclusions: This pilot study suggests that targeted intraoperative volume therapy reduces the incidence of postoperative wound infections and organdy functions and thus the consumption of resources. this is the first multicenter study, which shows a positive effect on patient outcome by the perioperative use of extended hemodynamic monitoring. Courtesy of Edwards Lifesciences, Irvine, USA