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Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial.

ABSTRACT: Study Objective: This study aimed to investigate whether stroke volume variation (SVV)-guided goal-directed therapy (GDT) can improve postoperative outcomes in elderly patients undergoing minimally invasive esophagectomy (MIE) compared with conventional care. Design: A prospective, randomized, controlled study. Setting: A single tertiary care center with a study period from November 2017 to December 2018. Patients: Patients over 65 years old who were scheduled for elective MIE. Interventions: The GDT protocol included a baseline fluid supplement of 7 ml/kg/h Ringer's lactate solution and SVV optimization using colloid boluses assessed by pulse-contour analysis (PiCCO™). When SVV exceeded 11%, colloid was infused at a rate of 50 ml per minute; if SVV returned below 9% for at least 2 minutes, then colloid was stopped. Measurements: The primary outcome was the incidence of postoperative complications before discharge, as assessed using a predefined list, including postoperative anastomotic leakage, postoperative hoarseness, postoperative pulmonary complications, chylothorax, myocardial injury, and all-cause mortality. Main Results: Sixty-five patients were included in the analysis. The incidence of postoperative complications between groups was similar (GDT 36.4% vs. control 37.5%, P = 0.92). The total fluid volume was not significantly different between the two groups (2,192 ± 469 vs. 2,201 ± 337 ml, P = 0.92). Compared with those in the control group (n = 32), patients in the GDT group (n = 33) received more colloids intraoperatively (874 ± 369 vs. 270 ± 67 ml, P <0.05) and less crystalloid fluid (1,318 ± 386 vs. 1,937 ± 334 ml, P <0.05). Conclusion: The colloid-based SVV optimization during GDT did not significantly reduce the incidence of early postoperative complications after minimally invasive esophagectomy in elderly patients. Clinical Trial Number and Registry URL: ChiCTR-INR-17013352; http://www.chictr.org.cn/showproj.aspx?proj=22883.

SUBMITTER: Tang W

PROVIDER: S-EPMC8685214 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundKidney transplantation is considered the first-choice therapy in end-stage renal disease (ESRD) patients. Despite recent improvements in terms of outcomes and graft survival in recipients, postoperative complications still concern the health-care providers involved in the management of those patients. Particularly challenging are cardiovascular complications. Perioperative goal-directed fluid-therapy (PGDT) and hemodynamic optimization are widely used in high-risk surgical patients and are associated with a significant reduction in postoperative complication rates and length of stay (LOS). The aim of this work is to compare the effects of perioperative goal-directed therapy (PGDT) with conventional fluid therapy (CFT) and to determine whether there are any differences in major postoperative complications rates and delayed graft function (DGF) outcomes.MethodsProspective study with historical controls. Two groups, a PGDT and a CFT group, were used: The stroke volume (SV) optimization protocol was applied for the PGDT group throughout the procedure. Conventional fluid therapy with fluids titration at a central venous pressure (CVP) of 8⁻12 mmHg and mean arterial pressure (MAP) >80 mmHg was applied to the control group. Postoperative data collection including vital signs, weight, urinary output, serum creatinine, blood urea nitrogen, serum potassium, and assessment of volemic status and the signs and symptoms of major postoperative complications occurred at 24 h, 72 h, 7 days, and 30 days after transplantation.ResultsAmong the 66 patients enrolled (33 for each group) similar physical characteristics were proved. Good functional recovery was evident in 92% of the CFT group, 98% of the PGDT group, and 94% of total patients. The statistical analysis showed a difference in postoperative complications as follows: Significant reduction of cardiovascular complications and DGF episodes (p < 0.05), and surgical complications (p < 0.01). There were no significant differences in pulmonary or other complications.ConclusionsPGDT and SV optimization effectively influenced the rate of major postoperative complications, reducing the overall morbidity and thus the mortality in patients receiving kidney transplantation.

Project description:BackgroundThe choice of anastomosis technique after esophagectomy is closely associated with the postoperative complications. Whether circular stapled or linear stapled anastomosis is the optimal technique has not been established. Therefore, we conducted this meta-analysis to show the latest and most comprehensive published assessment of circular stapled anastomosis in comparison with linear stapled anastomosis in postoperative complications.MethodsDatabases (PubMed, Embase, Web of science, Cochrane Library) were searched for all randomized controlled trials and comparative studies comparing circular stapled anastomosis with linear stapled anastomosis after esophagectomy. The odd ratio and mean difference with 95% confidence interval were calculated. We used the Higgins I² statistics to assess the statistical heterogeneity between studies. Review manager (version 5.4) software was used in this analysis.ResultsSixteen studies with 2322 patients were included in our study. The study demonstrated that the use of linear stapled technique after esophagectomy could reduce the risk of both anastomotic leakage (P = 0.0003) and stricture (P < 0.00001) compared with circular stapled technique. Stratification by anastomotic site showed that no matter what kind of anastomotic site (cervical or thoracic anastomosis) was used, linear stapled anastomosis could effectively reduce the anastomotic stricture in comparison with circular stapled anastomosis. Moreover, linear stapled anastomosis could decrease the risk of thoracic anastomotic leakage. There were no significant differences between circle stapled anastomosis and linear stapled anastomosis in reflux esophagitis (P = 0.17), pneumonia (P = 0.91), operation time (P = 0.41) and hospital stay (P = 0.38).ConclusionsThe study suggested that linear stapled anastomosis could be considered to be an optimal treatment associated with a reduced risk of anastomotic leakage and stricture in comparison with circular stapled anastomosis.

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Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial.

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