Effects of goal-directed fluid therapy on postoperative outcomes in patients undergoing laparoscopic colorectal surgery in different levels of systemic vascular resistance after general anesthesia
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ABSTRACT:
DISEASE(S): Colorectal Cancer
PROVIDER: 2683790 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:Interventions: TG group:GDFT combined with traditional ventilation;PG group:GDFT and LPS
Primary outcome(s): Respiratory dynamics index
Study Design: Parallel
| 2716233 | ecrin-mdr-crc
Project description:Interventions: Group GDFT:Goal-directed fluid therapy;Group control:Traditional fluid therapy
Primary outcome(s): IFABP;D-lactic acid;SVV;CI;Q-40 score
Study Design: Parallel
| 2700173 | ecrin-mdr-crc
Project description:Optimal perioperative fluid management is crucial, with over- or under-replacement associated with complications. There are many strategies for fluid therapy, including liberal fluid therapy (LFT), restrictive fluid therapy (RFT) and goal-directed fluid therapy (GDT), without a clear consensus as to which is better. We aimed to find out which is the more effective fluid therapy option in adult surgical patients undergoing non-vascular abdominal surgery in the perioperative period. This study is a systematic review and network meta-analysis (NMA) with node-splitting analysis of inconsistency, sensitivity analysis and meta-regression. We conducted a literature search of Pubmed, Cochrane Library, EMBASE, Google Scholar and Web of Science. Only studies comparing restrictive, liberal and goal-directed fluid therapy during the perioperative phase in major non-cardiac surgery in adult patients will be included. Trials on paediatric patients, obstetric patients and cardiac surgery were excluded. Trials that focused on goal-directed therapy monitoring with pulmonary artery catheters and venous oxygen saturation (SvO2), as well as those examining purely biochemical and laboratory end points, were excluded. A total of 102 randomised controlled trials (RCTs) and 78 studies (12,100 patients) were included. NMA concluded that goal-directed fluid therapy utilising FloTrac was the most effective intervention in reducing the length of stay (LOS) (surface under cumulative ranking curve (SUCRA) = 91%, odds ratio (OR) = -2.4, 95% credible intervals (CrI) = -3.9 to -0.85) and wound complications (SUCRA = 86%, OR = 0.41, 95% CrI = 0.24 to 0.69). Goal-directed fluid therapy utilising pulse pressure variation was the most effective in reducing the complication rate (SUCRA = 80%, OR = 0.25, 95% CrI = 0.047 to 1.2), renal complications (SUCRA = 93%, OR = 0.23, 95% CrI = 0.045 to 1.0), respiratory complications (SUCRA = 74%, OR = 0.42, 95% CrI = 0.053 to 3.6) and cardiac complications (SUCRA = 97%, OR = 0.067, 95% CrI = 0.0058 to 0.57). Liberal fluid therapy was the most effective in reducing the mortality rate (SUCRA = 81%, OR = 0.40, 95% CrI = 0.12 to 1.5). Goal-directed therapy utilising oesophageal Doppler was the most effective in reducing anastomotic leak (SUCRA = 79%, OR = 0.45, 95% CrI = 0.12 to 1.5). There was no publication bias, but moderate to substantial heterogeneity was found in all networks. In preventing different complications, except mortality, goal-directed fluid therapy was consistently more highly ranked and effective than standard (SFT), liberal or restricted fluid therapy. The evidence grade was low quality to very low quality for all the results, except those for wound complications and anastomotic leak.
| S-EPMC10226838 | biostudies-literature
Project description:Introduction:Optimal fluid balance is critical to minimize anastomotic edema in patients undergoing pancreaticoduodenectomy. We examined the effects of decreased fluid administration on rates of postoperative pancreatic leak and delayed gastric emptying. Methods:Retrospective study of 105 patients undergoing pancreaticoduodenectomy at a single institution from January 2015 through July 2016. Stroke volume variation (SVV) was tracked and titrated during the procedure. A comparative analysis of postoperative complications was performed between patients with a median SVV?<?12 during the extirpative and reconstructive phases of the procedure compared with patients with an SVV???12. Results:Of 64 patients who met selection criteria, 42 (65.6%) had a SVV?<?12 and 22 (34.4%) had a SVV???12. Patients with an SVV???12 during the extirpative phase of the procedure had lower rates of postoperative pancreatic leaks compared to patients with an SVV?<?12 (5.9% vs 21.3%)). Patients with an SVV???12 during the extirpative phase had lower rates of postoperative delayed gastric emptying compared to patients with an SVV?<?12 (41.2% vs 46.8%). Conclusion:Goal-directed fluid restriction before the reconstructive phase of pancreaticoduodenectomy may contribute to lower postoperative rates of pancreatic leak and delayed gastric emptying.
| S-EPMC6199772 | biostudies-literature
Project description:BackgroundIntraoperative fluid management is important for the prevention of perioperative morbidity and mortality. Our study aimed to investigate the perioperative feasibility and benefits of Goal-Directed Fluid Management (GDFM) using noninvasive hemodynamic monitoring in gynecologic oncology patients with acute blood loss and severe fluid loss. We assessed the effects of GDFM on hemodynamics, organ perfusion, complications, and mortality outcomes.MethodsThis randomized prospective study included 104 patients over the age of 18 years, including 56 patients with endometrial cancer and 48 patients with ovarian cancer who had open surgery. The anesthetic approach was standardized for all patients. We compared the perioperative results of the subjects who were randomized into GDFM (n = 51) and Liberal Fluid Management (LFM) (n = 53) groups using a computer program.ResultsThe median perioperative crystalloid replacement (2000 vs. 2700; p < 0.001) and total volume of fluid (2260 vs. 3200; p < 0.001) were lower in the GDFM group compared to the LFM group. The hemodynamic findings and the HCO3 and lactate levels of the GDFM group did not significantly change perioperatively. The heart rate, mean arterial pressure, and HCO3 levels of the LFM group decreased and serum lactate levels increased perioperatively. The hospitalization rate in ICU (7.8% vs. 28.3%; p = 0.010), rate of patients with comorbidity conditions indicated in ICU (2% vs. 17%; p = 0.024), and rate of complications (17.6% vs. 35.8%; p = 0.047) were lower in the GDFM group compared to the LFM group.ConclusionThe amount of intraoperatively administered crystalloid solution and complication rates were significantly lower in gynecologic oncologic surgery patients who received GDFM. Besides, hemodynamic findings, and lactate levels of the GDFM group did not change significantly during the perioperative period.
| S-EPMC9373248 | biostudies-literature
Project description:BackgroundInduction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known.MethodsAn intravenous infusion of 25?mL?kg-?1 of Ringer's lactate was infused over 30?min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence.ResultsDistribution of infused fluid was interrupted during the first 20?min of the infusions. During this time 16.6?mL?kg-?1 of lactated Ringer's had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k10), which remained to be very low (0.86?×?10-?3?min-?1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate.ConclusionsInduction of general anesthesia interrupted the distribution of lactated Ringer's solution up to when 16.6?mL?kg-?1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced.Trial registrationControlled-trials.com (ISRCTN81005631) on May 17, 2016 (retrospectively registered).
| S-EPMC7183132 | biostudies-literature
Project description:What are the cortical neural correlates that distinguish goal-directed and non-goal-directed movements? We investigated this question in the monkey frontal eye field (FEF), which is implicated in voluntary control of saccades. Here, we compared FEF activity associated with goal-directed (G) saccades and non-goal-directed (nG) saccades made by the monkey. Although the FEF neurons discharged before these nG saccades, there were three major differences in the neural activity: First, the variability in spike rate across trials decreased only for G saccades. Second, the local field potential beta-band power decreased during G saccades but did not change during nG saccades. Third, the time from saccade direction selection to the saccade onset was significantly longer for G saccades compared with nG saccades. Overall, our results reveal unexpected differences in neural signatures for G versus nG saccades in a brain area that has been implicated selectively in voluntary control. Taken together, these data add critical constraints to the way we think about saccade generation in the brain.
| S-EPMC8017686 | biostudies-literature
Project description:BackgroundThe effect a restrictive goal directed therapy (GDT) fluid protocol combined with an enhanced recovery after surgery (ERAS) programme on hospital stay for patients undergoing major liver resection is unknown.MethodsWe conducted a multicentre randomized controlled pilot trial evaluating whether a patient-specific, surgery-specific intraoperative restrictive fluid optimization algorithm would improve duration of hospital stay and reduce perioperative fluid related complications.ResultsForty-eight participants were enrolled. The median (IQR) length of hospital stay was 7.0 days (7.0:8.0) days in the restrictive fluid optimization algorithm group (Restrict group) vs. 8.0 days (6.0:10.0) in the conventional care group (Conventional group) (Incidence rate ratio 0.85; 95% Confidence Interval 0.71:1.1; p = 0.17). No statistically significant difference in expected number of complications per patient between groups was identified (IRR 0.85; 95%CI: 0.45-1.60; p = 0.60). Patients in the Restrict group had lower intraoperative fluid balances: 808 mL (571:1565) vs. 1345 mL (900:1983) (p = 0.04) and received a lower volume of fluid per kg/hour intraoperatively: 4.3 mL/kg/hr (2.6:5.8) vs. 6.0 mL/kg/hr (4.2:7.6); p = 0.03. No significant differences in the proportion of patients who received vasoactive drugs intraoperatively (p = 0.56) was observed.ConclusionIn high-volume hepatobiliary surgical units, the addition of a fluid restrictive intraoperative cardiac output-guided algorithm, combined with a standard ERAS protocol did not significantly reduce length of hospital stay or fluid related complications. Our findings are hypothesis-generating and a larger confirmatory study may be justified.
| S-EPMC6642079 | biostudies-literature
Project description:BackgroundSeveral randomized controlled trials suggest that goal-directed fluid therapy (GDFT) may result in improved postoperative outcomes. The aim of this study was to assess the clinical and financial impact of the real-life implementation of intraoperative GDFT in patients undergoing elective gastrointestinal surgery in a Chinese tertiary medical center.MethodsThis Quality Improvement Program (QIP) study comprised three phases of 5, 1, and 5 months, respectively. During the first phase, we retrospectively collected perioperative data from patients who received standard intraoperative fluid management from January to May 2016. Then a 1-month training period allowed the clinical staff to become familiar with the GDFT protocol. After the training phase, GDFT was used from July to November 2016. In the GDFT group, stroke volume (SV) was continuously monitored and optimized towards the plateau of the Frank-Starling curve. The primary outcome measure was postoperative morbidity (the proportion of patients with one or more complications within 30 days after surgery). Secondary outcomes were total hospital cost, postoperative length of hospital stay, and 30-day mortality.ResultsData from 200 patients before (control group) and 201 patients after the implementation of GDFT (GDFT group) were collected and compared. There was no significant difference in demographics and surgical procedures between the two groups. Postoperative morbidity was significantly lower in the GDFT group than in the control group (30.8% vs. 44.0%, p = 0.006). No significant differences were observed for mean total hospital cost (76,793 RMB vs. 74,444 RMB; p = 0.430), median postoperative length of hospital stay (10 days vs. 10 days; p = 0.104), and 30-day mortality (1% vs. 0.5%; p = 0.565).ConclusionIn patients undergoing gastrointestinal surgery, the implementation of a GDFT protocol was associated with a reduction in postoperative morbidity without increasing costs.Trial registrationclinicaltrials.gov, NCT02507557. Registered 13 July 2015.
| S-EPMC6171290 | biostudies-literature
Project description:BACKGROUND:Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e.g. infection, cardiac, neurological, renal) (primary outcome) and hospital and intensive care unit (ICU) length of stay (secondary outcomes). METHODS:We developed a GDFT protocol for the haemodynamic management of patients undergoing hip revision arthroplasty. The GDFT protocol was based on continuous monitoring and optimization of stroke volume during the surgical procedure. From December 2012 and for a period of 17 months, 130 patients were treated according to the GDFT protocol (GDFT group). The pre-, intra-, and postoperative characteristics of patients from the GDFT group were compared to those of 130 historical matched patients (control group) who had the same surgery between January 2011 and August 2012. RESULTS:Patients from the GDFT and from the control group were comparable in terms of age, comorbidities, and P-POSSUM score. Duration of anaesthesia and surgery were also comparable. The GDFT group had a significantly lower morbidity rate (49.2 vs. 66.9%; p?=?0.006) and a shorter median hospital length of stay (11 days (9-15) vs. 9 days (8-12); p?=?0.003) than the control group. Patients from the control group post-anaesthesia care unit (PACU)/ICU stayed significantly longer at PACU/ICU than patients from the GDFT group (control group vs. GDFT group, 960 min (360-1210) vs. 400 min (207-825); p?<?0.001) Patients from the GDFT group received less crystalloids but more colloids during surgery. They also received more often inotropic therapy. CONCLUSIONS:In patients undergoing hip revision arthroplasty, the implementation of GDT as a new standard operating procedure was successful and associated with reduced postsurgical complications, most importantly a reduction in postoperative bleeding as well as hospital and ICU stay. TRIAL REGISTRATION:ClinicalTrials.gov, NCT01753050.
| S-EPMC5154150 | biostudies-literature