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
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
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DOI：
10.1186/cc12885
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发表时间：
2013-01-01
期刊：
影响因子：
15.1
通讯作者：
Reuter, Daniel A.
中科院分区：
文献类型：
--
作者：
Salzwedel, Cornelie;Puig, Jaume;Reuter, Daniel A.
简介：多项单中心研究和荟萃分析表明，围手术期目标导向治疗可显著改善普外科患者的结局。我们假设，与对照组（CG）相比，研究组（SG）中使用基于脉压变化、桡动脉脉搏轮廓分析的心脏指数趋势和平均动脉压的治疗算法，将导致腹部手术患者术后并发症减少、住院时间缩短和排便恢复更快。方法：接受择期腹部大手术的160例患者被随机分配至SG组（79例患者）或CG组（81例患者）。在SG中，通过脉压变化、心脏指数趋势和平均动脉压指导血流动力学治疗。在CG中，由治疗麻醉师酌情进行血流动力学治疗。结果数据记录到28天postoperatives.Results：并发症的总数是显着较低的SG（72与52并发症，p = 0.038）。特别是，感染并发症显著减少（SG：13 vs. CG：26例并发症，p = 0.023）。两组排便恢复情况无显著差异（SG：3 vs. CG：术后2天，p = 0.316），麻醉后监护室停留时间（SG：180 vs. CG：180分钟，p = 0.516）或住院时间（SG：11 vs. CG：10天，p = 0.929）。这项多中心研究表明，使用脉压变化的血流动力学目标导向治疗，心脏指数趋势和平均动脉压作为关键参数导致接受腹部大手术的患者的术后并发症减少。
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 (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).Methods: 160 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.Results: The 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).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.