Closed-loop assisted versus manual goal-directed fluid therapy during high-risk abdominal surgery: a case-control study with propensity matching.
Closed-loop assisted versus manual goal-directed fluid therapy during high-risk abdominal surgery: a case-control study with propensity matching.
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DOI：
10.1186/s13054-015-0827-7
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发表时间：
2015-03-19
期刊：
影响因子：
--
通讯作者：
Cannesson M
中科院分区：
文献类型：
--
作者：
Rinehart J;Lilot M;Lee C;Joosten A;Huynh T;Canales C;Imagawa D;Demirjian A;Cannesson M
目标导向的液体治疗策略已被证明对中高危手术患者有益。尽管如此，这些战略往往得不到执行。本研究的目的是评估手术队列中的闭环液体给药系统，并将结果与接受手动管理的匹配患者的结果进行比较。我们的假设是，接受闭环辅助的患者将花费更多时间处于前负荷独立状态，定义为每搏输出量变化小于或等于12%的病例时间百分比。符合研究条件的患者均为18岁以上计划接受肝胆、胰腺或脾脏手术的患者，预期接受血管内动脉血压监测作为麻醉护理的一部分。闭环复苏目标由初级麻醉团队选择，系统负责在手术期间实施目标导向的液体治疗。入组完成后，使用倾向匹配将每例研究患者与同一时间段内进行的非闭环辅助病例进行匹配，以减少偏倚。共入组了40例患者，5例最终被排除，在预定卡尺距离内的剩余35例患者中选择了25对匹配对。两组间液体给药无显著差异。闭环组在前负荷独立状态下的病例时间比例显著较高（95 ± 6%的病例时间vs 87 ± 14%，P =0.008）。病例平均或最终每搏输出量指数（分别为45 ± 10 vs 43 ± 9和45 ± 11 vs 42 ± 11）或平均动脉压（79 ± 8 vs 83 ± 9）无差异。闭环辅助组的病例结束心率显著较低（77 ± 10 vs 88 ± 13，P =0.003）。在这项倾向匹配的病例对照研究中，与目标导向液体治疗的手动输送相比，临床医生使用闭环辅助导致在整个手术过程中，大部分病例时间处于前负荷独立状态。ClinicalTrials.gov标识符：NCT 02020863。注册日期2013年12月19日本文的在线版本（doi：10.1186/s13054-015-0827-7）包含补充材料，可供授权用户使用。
Goal-directed fluid therapy strategies have been shown to benefit moderate- to high-risk surgery patients. Despite this, these strategies are often not implemented. The aim of this study was to assess a closed-loop fluid administration system in a surgical cohort and compare the results with those for matched patients who received manual management. Our hypothesis was that the patients receiving closed-loop assistance would spend more time in a preload-independent state, defined as percentage of case time with stroke volume variation less than or equal to 12%. Patients eligible for the study were all those over 18 years of age scheduled for hepatobiliary, pancreatic or splenic surgery and expected to receive intravascular arterial blood pressure monitoring as part of their anesthetic care. The closed-loop resuscitation target was selected by the primary anesthesia team, and the system was responsible for implementation of goal-directed fluid therapy during surgery. Following completion of enrollment, each study patient was matched to a non–closed-loop assisted case performed during the same time period using a propensity match to reduce bias. A total of 40 patients were enrolled, 5 were ultimately excluded and 25 matched pairs were selected from among the remaining 35 patients within the predefined caliper distance. There was no significant difference in fluid administration between groups. The closed-loop group spent a significantly higher portion of case time in a preload-independent state (95 ± 6% of case time versus 87 ± 14%, P =0.008). There was no difference in case mean or final stroke volume index (45 ± 10 versus 43 ± 9 and 45 ± 11 versus 42 ± 11, respectively) or mean arterial pressure (79 ± 8 versus 83 ± 9). Case end heart rate was significantly lower in the closed-loop assisted group (77 ± 10 versus 88 ± 13, P =0.003). In this case–control study with propensity matching, clinician use of closed-loop assistance resulted in a greater portion of case time spent in a preload-independent state throughout surgery compared with manual delivery of goal-directed fluid therapy. ClinicalTrials.gov Identifier: NCT02020863. Registered 19 December 2013 The online version of this article (doi:10.1186/s13054-015-0827-7) contains supplementary material, which is available to authorized users.
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影响因子：
15.1
作者：
Salzwedel, Cornelie;Puig, Jaume;Reuter, Daniel A.
通讯作者：
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