Individually Optimized Hemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit

Goepfert, Matthias S.; Richter, Hans Peter; Eulenburg, Christine zu; Gruetzmacher, Janna; Rafflenbeul, E.; Röher, Katharina; Sandersleben, Alexandra von; Diedrichs, Stefan; Reichenspurner, H.; Goetz, Alwin E.; Reuter, Daniel A.

doi:10.1097/aln.0b013e31829bd770

Cited by 157 publications

(87 citation statements)

References 49 publications

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“…Current perioperative ‘goal-directed therapy’ studies have been focused mainly on systemic haemodynamic parameters [11,39] and may contribute to improvements in survival after major surgery by using perioperative plasma volume expansion [12,39] or a more restricted fluid approach [40]. Moreover, there is to date no uniform goal-directed strategy aimed at resuscitation of regional peripheral blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, the success of early, goal-directed haemodynamic therapy has demonstrated the importance of maintaining and improving tissue oxygenation and has shown that early detection and correction of altered tissue perfusion reduce postoperative complications [2,11]. Accordingly, their importance is also the basis for stressing the need to monitor postoperative early warning signals for occult tissue hypoperfusion [2,12].…”

Section: Introductionmentioning

confidence: 99%

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Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults

et al. 2014

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IntroductionAltered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications.MethodsHaemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (Tskin-diff). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification.ResultsWe prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and Tskin-diff were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6).ConclusionsIn a group of patients assessed following major abdominal surgery, peripheral perfusion alterations were associated with the development of severe complications independently of systemic haemodynamics. Further research is needed to confirm these findings and to explore in more detail the effects of peripheral perfusion–targeted resuscitation following major abdominal surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults

et al. 2014

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“…Several studies have clearly demonstrated the beneficial effects of this approach in cardiac surgery. [10][11][12][13][14][15] However, the changes in ScvO 2, ∆Pv-aCO 2 and lactate reflect different pathophysiological processes and events. Therefore, adequate evaluation of each parameter and their relationship could be helpful to manage intensive care.…”

Section: Introductionmentioning

confidence: 96%

Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study

Lenkin

Smetkin

Hussain

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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“…Considering the large variability of biometric parameters such as body weight (BW) and height volumetric parameters are usually adjusted for these biometric variables to improve inter-individual comparisons and to allow for homogenous normal ranges. GEDV indexed to body surface area (BSA) is termed GEDVI and has been demonstrated to be useful in assessing preload and to guide fluid therapy in several studies [1][2][3][4][5][6][7]. Nevertheless, some studies using algorithms based on GEDVI have failed to improve outcome [8,9].…”

Section: Introductionmentioning

confidence: 98%

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

Huber

Mair

Götz

et al. 2016

J Clin Monit Comput

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Global end-diastolic volume (GEDV) has been indexed to body surface area (BSA). However, data validating this indexation of GEDV are scarce. Furthermore, it has been suggested to index GEDV to "predicted BSA" based on predicted body weight. Therefore, we aimed to identify biometric parameters independently associated with GEDV. We analyzed a database including 3812 TPTD measurements in 234 patients treated in the ICU of a German university hospital. GEDVI indexed to actual BSA was significantly lower than GEDVI indexed to predicted BSA (748 ± 179 vs. 804 ± 190 mL/m; p < 0.001). GEDV was independently associated with older age, male sex, height, and actual body weight. In a regression model for the estimation of GEDV, age and height were the most important parameters: Each year in age and each cm in height increased GEDV by 9 and 15 mL, respectively. In addition to height and weight also age and sex should be considered for indexation of GEDV.

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Individually Optimized Hemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit

Abstract: Early goal-directed hemodynamic therapy based on cardiac index, stroke volume variation, and optimized global end-diastolic volume index reduces complications and length of ICU stay after cardiac surgery.

Cited by 157 publications

References 49 publications

Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults

Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults

Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume

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