Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?

Chong, Matthew; Wang, Yongjun; Berbenetz, Nicolas M.; McConachie, Ian

doi:10.1097/eja.0000000000000778

Cited by 178 publications

(153 citation statements)

References 96 publications

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…This is to our knowledge one of the first descriptions of the use of this technique during kidney transplantation in children and one of the most noteworthy differences between France and other countries. Although adult evidence clearly supports optimizing cardiac output during adult high‐risk surgery in order to decrease both perioperative complications and mortality, studies are still lacking in children, especially during kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

A survey of the anesthetic management of pediatric kidney transplantation in France

Marsac

Michelet

Sola

et al. 2019

Pediatric Transplantation

View full text Add to dashboard Cite

Background Renal transplantation is the best available therapeutic option for end‐stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. Material and Methods The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). Results Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. Conclusions The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.

show abstract

Section: Discussionmentioning

confidence: 99%

A survey of the anesthetic management of pediatric kidney transplantation in France

Marsac

Michelet

Sola

et al. 2019

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…In combination with a goal-directed hemodynamic monitoring protocol and the application of vasopressors and inotrope medication, a reduction of mortality by 58 was observed in a recent meta-analysis [90]. Whether goal-directed volume therapy can reduce perioperative mortality still needs to be demonstrated in larger multicenter studies.…”

Section: Discussionmentioning

confidence: 99%

“…Over the last decade, several GDT protocols have been introduced and evaluated. A recent meta-analysis summarized 95 randomized-controlled trials and was able to show a GDT-induced reduction in mortality, morbidity, and length of hospital stay [90]. Contrastingly, the Optimisation of Cardiovascular Management to Improve Surgical Outcome (OPTIMISE) study was not able to prove the benefits of GDT [88].…”

Section: Deresuscitation Strategies Using Monitoring Of Volume Statusmentioning

confidence: 98%

Management of perioperative volume therapy – monitoring and pitfalls

Sander

Schneck

Habicher

2020

Korean J Anesthesiol

View full text Add to dashboard Cite

Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

show abstract

“…The incidence of postoperative morbidity in terms of complications was 23% in this study with ASA status score 3 or more being one of the predictive factors among five others. In adults, a systematic review and metaanalysis demonstrated that intraoperative goal directed fluid and hemodynamic therapy (GDFHT) in high risk patient ' s improved postoperative outcome in terms of mortality and morbidity [2]. In children, the impact of GDFHT on postoperative outcome has not yet been evidenced.…”

Section: Introductionmentioning

confidence: 99%

Goal directed fluid and hemodynamic therapy with trans-thoracic echocardiographic aortic blood flow peak velocity variation in children and postoperative outcome : A randomized controlled trial protocol

Kumba¹

2020

Adv Pediatr Res

View full text Add to dashboard Cite

show abstract

Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?

Cited by 178 publications

References 96 publications

A survey of the anesthetic management of pediatric kidney transplantation in France

A survey of the anesthetic management of pediatric kidney transplantation in France

Management of perioperative volume therapy – monitoring and pitfalls

Goal directed fluid and hemodynamic therapy with trans-thoracic echocardiographic aortic blood flow peak velocity variation in children and postoperative outcome : A randomized controlled trial protocol

Contact Info

Product

Resources

About