Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery
Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery
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DOI：
10.1093/bja/aer273
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发表时间：
2012-01-01
影响因子：
9.8
通讯作者：
Minto, G.
中科院分区：
文献类型：
--
作者：
Challand, C.;Struthers, R.;Minto, G.
背景使用食管多普勒监测（ODM）优化每搏输出量（SV）的术中液体治疗方案（目标导向液体治疗，GDT）与大手术后住院时间（LOS）和并发症发生率的减少相关。我们假设术中GDT将缩短择期结直肠手术患者的手术准备出院时间（RfD），但这种效果在有氧健康的患者中可能不太明显。在这项双盲对照试验中，179例接受大型开放式或腹腔镜结直肠手术的患者根据心肺运动试验期间的表现被描述为有氧“适合”（n = 123）或“不适合”（n = 56）。在这些适应性分层中，患者随机接受标准液体方案，有或没有ODM引导的术中GDT。GDT患者平均额外接受1360 ml术中胶体。GDT组皮肤闭合时的平均心脏指数和SV显著高于对照组。GDT患者的RfD和LOS时间长于对照组患者，但未达到统计学显著性（中位数分别为6.8 vs 4.9天，P = 0.09，中位数分别为8.8 vs 6.7天，P = 0.09）。与对照组相比，GDT患者的RfD（中位数7.0 vs 4.7天; P = 0.01）和LOS（中位数8.8 vs 6.0天; P = 0.01）增加。术中SV优化与标准液体治疗相比没有额外获益。在有氧适应亚组患者中，GDT与主要结局的有害影响相关。14680495.http://public.ukcrn.org.uk/Search/StudyDetail.aspx?研究ID =7285。
Background. Intraoperative fluid therapy regimens using oesophageal Doppler monitoring (ODM) to optimize stroke volume (SV) (goal-directed fluid therapy, GDT) have been associated with a reduction in length of stay (LOS) and complication rates after major surgery. We hypothesized that intraoperative GDT would reduce the time to surgical readiness for discharge (RfD) of patients having major elective colorectal surgery but that this effect might be less marked in aerobically fit patients.Methods. In this double-blinded controlled trial, 179 patients undergoing major open or laparoscopic colorectal surgery were characterized as aerobically 'fit' (n = 123) or 'unfit' (n = 56) on the basis of their performance during a cardiopulmonary exercise test. Within these fitness strata, patients were randomized to receive a standard fluid regimen with or without ODM-guided intraoperative GDT.Results. GDT patients received an average of 1360 ml of additional intraoperative colloid. The mean cardiac index and SV at skin closure were significantly higher in the GDT group than in controls. Times to RfD and LOS were longer in GDT than control patients but did not reach statistical significance (median 6.8 vs 4.9 days, P = 0.09, and median 8.8 vs 6.7 days, P = 0.09, respectively). Fit GDT patients had an increased RfD (median 7.0 vs 4.7 days; P = 0.01) and LOS (median 8.8 vs 6.0 days; P = 0.01) compared with controls.Conclusions. Intraoperative SV optimization conferred no additional benefit over standard fluid therapy. In an aerobically fit subgroup of patients, GDT was associated with detrimental effects on the primary outcome.Trial registry: UK NIHR CRN 7285, ISRCTN 14680495.http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7285.