Impact of early haemodynamic goal-directed therapy in patients undergoing emergency surgery: an open prospective, randomised trial.
Haemodynamic goal-directed therapies (GDT) may improve outcome following elective major surgery. So far, few data exist regarding haemodynamic optimization during emergency surgery. In this randomized, controlled trial, 50 surgical patients with hypovolemic or septic conditions were enrolled and we...
| Publicado en: | Journal of Clinical Monitoring & Computing Vol. 30; no. 1; pp. 87 - 100 |
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| Autores principales: | , , , , , , |
| Formato: | research randomized controlled trial Journal Article |
| Publicado: |
Springer Nature
Feb2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112814886&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 112814886 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13871307 OHC jtl: Journal of Clinical Monitoring & Computing issn: 13871307 maglogo: N pubinfo: dt: Feb2016 vid: 30 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 112814886 112814886 NLM25851818 112814886 10.1007/s10877-015-9691-x NLM25851818 112814886 ppf: 87 ppct: 13 formats: fmt: @attributes: type: P tig: atl: Impact of early haemodynamic goal-directed therapy in patients undergoing emergency surgery: an open prospective, randomised trial. aug: au: Pavlovic, Gordana Diaper, John Ellenberger, Christoph Frei, Angela Bendjelid, Karim Bonhomme, Fanny Licker, Marc affil: Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital Geneva, rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland sug: subj: Surgery, Operative Methods Algorithms Emergency Treatment Methods Heart Function Tests Methods Fluid Therapy Methods Patient Care Plans Male Sensitivity and Specificity Aged Middle Age Human Reproducibility of Results Recurrence Prevention and Control Prospective Studies Treatment Outcomes Intraoperative Monitoring Methods Female Validation Studies Comparative Studies Evaluation Research Multicenter Studies Randomized Controlled Trials Scales Aged: 65+ years Middle Aged: 45-64 years Male Female ab: Haemodynamic goal-directed therapies (GDT) may improve outcome following elective major surgery. So far, few data exist regarding haemodynamic optimization during emergency surgery. In this randomized, controlled trial, 50 surgical patients with hypovolemic or septic conditions were enrolled and we compared two algorithms of GDTs based either on conventional parameters and pressure pulse variation (control group) or on cardiac index, global end-diastolic volume index and stroke volume variation as derived from the PiCCO monitoring system (optimized group). Postoperative outcome was estimated by a composite index including major complications and by the Sequential Organ Failure Assessment (SOFA) Score within the first 3 days after surgery (POD1, POD2 and POD3). Data from 43 patients were analyzed (control group, N = 23; optimized group, N = 20). Similar amounts of fluid were given in the two groups. Intraoperatively, dobutamine was given in 45 % optimized patients but in no control patients. Major complications occurred more frequently in the optimized group [19 (95 %) versus 10 (40 %) in the control group, P < 0.001]. Likewise, SOFA scores were higher in the optimized group on POD1 (10.2 ± 2.5 versus 6.6 ± 2.2 in the control group, P = 0.001), POD2 (8.4 ± 2.6 vs 5.0 ± 2.4 in the control group, P = 0.002) and POD 3 (5.2 ± 3.6 and 2.2 ± 1.3 in the control group, P = 0.01). There was no significant difference in hospital mortality (13 % in the control group and 25 % in the optimized group). Haemodynamic optimization based on volumetric and flow PiCCO-derived parameters was associated with a less favorable postoperative outcome compared with a conventional GDT protocol during emergency surgery. pubtype: Academic Journal doctype: research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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