MON-PP269: Intraoperative Goal-Directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials

Rollins, Katie E.; Lobo, Dileep N.

doi:10.1016/s0261-5614(15)30701-9

Cited by 39 publications

(61 citation statements)

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“…However, the reported mortality rate was non-significantly lower with GDT than CT (7% vs. 11.6%). In line with this finding, Rollins & Lobo [23] and Som et al [24] found the use of GDT in major surgical patients does not decrease PO hospital 30-day mortality rate versus CT, while Kratz et al [21] reported non-significant difference in mortality rate of patients underwent pancreatic surgery before and after implementation of GDT.…”

Section: Parametermentioning

confidence: 81%

“…-Significance versus at 12-h levels complications and renal failure after implementation of GDT for patients underwent pancreatic resection. Moreover, multiple recent meta-analyses of published prospective randomized controlled trials comparing GDT with standard care found application of GDT based on dynamic parameters significantly reduced PO morbidity [22], was associated with significant reduction in ICU and hospital length of stay [23] and significantly lower frequency of abdominal complications, wound infection and PO hypotension [24].…”

Section: Parametermentioning

confidence: 99%

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Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Elgendy

Esmat

Kassim

2017

Egyptian Journal of Anaesthesia

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The Vigileo-FloTrac system High-risk patients Major abdominal surgeries Postoperative Morbidity Mortality a b s t r a c tBackground: This study evaluated impact of intraoperative goal-directed therapy (GDT) judged by changes of stroke volume variation (SVV) and cardiac index (CI) using the Vigileo/FloTrac system on postoperative (PO) morbidities and mortality rates in high risk patients scheduled for major abdominal surgeries in comparison to conventional fluid therapy (CT). Methods: 86 patients were randomly allocated into one of two equal groups: CT group = 43 patients received crystalloid solution and on demand bolus of 250 ml colloids with possible addition of vasopressor or inotrope to target MAP at 60-90 mmHg, CVP at 8-12 mmHg and urine output at >0.5 ml/kg/hr and GDT group = 43 patients received crystalloid fluid therapy (FT) and colloids (3 ml/kg) with possible addition of vasopressor or inotrope according to predefined protocol with a target CI 2.5 L/min/m 2 , SVV < 12% with MAP > 65 mmHg. Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) was used to predict morbidity and mortality rates. Study outcomes included ICU and total hospital morbidity and mortality rates and length of stay (LOS). Results: Intraoperative GDT reduced ICU morbidity rate (16.3%) than the POSSUM predicted rate (39.78%) and significantly (p = 0.039) than CT group (37.2%), while in CT group ICU morbidity rate coincided with POSSUM predicted rate (42.86%). ICU and total hospital LOS were significantly shorter with GDT group than with CT group. However, mortality rates weren't significantly lower with GDT group than CT group (7% vs. 11.6%). The applied protocol for intraoperative GDT reduced significantly crystalloid infusion and despite of significantly higher amount of received colloids, the total amount of FT was significantly less than CT group. Conclusion: The applied protocol for intraoperative GDT provided significant reduction of PO morbidities, ICU and hospital LOS but couldn't significantly reduce mortality rates in high risk patients scheduled for major abdominal surgeries.

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Section: Parametermentioning

confidence: 81%

Section: Parametermentioning

confidence: 99%

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Elgendy

Esmat

Kassim

2017

Egyptian Journal of Anaesthesia

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“…These lower-quality studies tend to magnify the benefits of the intervention being studied. Indeed, properly designed prospective studies have been revealing, showing that interventions which may improve outcomes under traditional perioperative management do not necessarily confer additional benefit when both groups are on ERAS pathways [16]. Hence, there is a need to formalize ERASrelated research such that meaningful results are reproducible and generalizable.…”

Section: Introductionmentioning

confidence: 99%

The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS^® and ERAS^® USA Societies

et al. 2018

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Background Enhanced recovery after surgery (ERAS) programs are multimodal care pathways designed to minimize the physiological and psychological impact of surgery for patients. Increased compliance with ERAS guidelines is associated with improved patient outcomes across surgical types. As ERAS programs have proliferated, an unintentional effect has been significant variation in how ERAS-related studies are reported in the literature. Methods To improve the quality of ERAS reporting, ERASÒ USA and the ERAS Ò Society launched an effort to create an instrument to assist authors in manuscript preparation. Criteria to include were selected by a combination of literature review and expert opinion. The final checklist was refined by group consensus. Results The Societies present the Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist. The tool contains 20 items including best practices for reporting clinical pathways, compliance auditing, and formatting guidelines. Conclusions The RECOvER Checklist is intended to provide a standardized framework for the reporting of ERASrelated studies. The checklist can also assist reviewers in evaluating the quality of ERAS-related manuscripts. Authors are encouraged to include the RECOvER Checklist when submitting ERAS-related studies to peer-reviewed journals.

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“…Peri‐operative goal‐directed haemodynamic therapy improves some outcomes after major surgery . Guidelines recommend titration of intravenous fluid using stroke volume .…”

Section: Introductionmentioning

confidence: 99%

Cardiac output monitoring with thermodilution pulse‐contour analysis vs. non‐invasive pulse‐contour analysis

et al. 2019

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Summary Intravenous fluid boluses guided by changes in stroke volume improve some outcomes after major surgery, but invasive measurments may limit use. From October 2016 to May 2018, we compared the agreement and trending ability of a photoplethysmographic device (Clearsight) with a PiCCO, calibrated by thermodilution, for haemodynamic variables in 20 adults undergoing major elective surgery. We analysed 4519 measurement pairs, including before and after 68 boluses of 250 ml crystalloid. The bias and precision of stroke volume measurement by Clearsight were −0.89 ± 4.78 ml compared with the invasive pulse‐contour cardiac output device. The coefficient of agreement for stroke volume variation after fluid boluses between the two devices was 0.79 (‘strong’). Fluid boluses that increased stroke volume by ≥ 10% increased mean absolute volume (SD) and mean percentage (SD) stroke volume measurements similarly for the invasive pulse‐contour cardiac output and Clearsight devices: 9 (4) ml vs. 8 (4) ml and 16% (8%) vs. 15% (10%), respectively, p > 0.05. The non‐invasive Clearsight pulse‐contour analysis was similar to an invasive pulse‐contour device in measuring absolute and changing stroke volumes during major surgery.

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MON-PP269: Intraoperative Goal-Directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials

Cited by 39 publications

References 0 publications

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS^® and ERAS^® USA Societies

Cardiac output monitoring with thermodilution pulse‐contour analysis vs. non‐invasive pulse‐contour analysis

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MON-PP269: Intraoperative Goal-Directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-Analysis of Randomized Controlled Trials

Cited by 39 publications

References 0 publications

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies

Cardiac output monitoring with thermodilution pulse‐contour analysis vs. non‐invasive pulse‐contour analysis

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Product

Resources

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The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS^® and ERAS^® USA Societies