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.
Crit Care
; 17(5): R191, 2013 Sep 08.
Article
em En
| MEDLINE
| ID: mdl-24010849
ABSTRACT
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. TRIAL REGISTRATION ClinicalTrial.gov, NCT01401283.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Planejamento de Assistência ao Paciente
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Complicações Pós-Operatórias
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Pressão Sanguínea
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Monitorização Intraoperatória
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Procedimentos Cirúrgicos Eletivos
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Assistência Perioperatória
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Hemodinâmica
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Observational_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Crit Care
Ano de publicação:
2013
Tipo de documento:
Article