Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Perel, Azriel

doi:10.1093/bja/aex282

Cited by 7 publications

(12 citation statements)

References 16 publications

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“…12 Indeed, it has been hypothesized that the individualization of fluid therapy is effective through timely replenishment of fluid for patients who are fluid responders and avoidance of fluid overload for those who do not. 10 With the guidance of IFM protocol, fluid responders are more likely to received more fluid and non-responders likely to receive less. This may explain why the average volume of fluid was comparable between groups.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Multicentre randomized controlled trials (RCTs) and meta-analyses suggest that IFM is beneficial in decreasing postoperative morbidity, shortening hospital length of stay and saving costs. [6][7][8][9][10][11] Most IFM studies have been conducted in patients undergoing major gastro-intestinal surgery . [10][11][12] A limited number of studies have been done among patients undergoing orthopaedic surgery and have yielded conflicting results.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9][10][11] Most IFM studies have been conducted in patients undergoing major gastro-intestinal surgery . [10][11][12] A limited number of studies have been done among patients undergoing orthopaedic surgery and have yielded conflicting results. For instance, in patients undergoing hip fracture surgery, a few studies 13,14 reported clinical benefits when using IFM, whereas others did not.…”

Section: Introductionmentioning

confidence: 99%

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Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Che

Zhang

et al. 2020

Preprint

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Background Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. A limited number of clinical studies have been done in orthopaedic patients and have yielded conflicting results. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery. Methods This is a before-after study done in 300 patients undergoing posterior spine arthrodesis. Postoperative outcomes were compared between control group implementing standard fluid management (n = 150) and IFM group (n = 150) guided by fluid protocol based on continuous stroke volume monitoring and optimization. The primary outcome measure was the proportion of patients who developed one or more complications within 30 days following surgery. Results During surgery, patients received on average the same volume of crystalloids (7.4 vs 7.2 ml/kg/h) and colloids (1.6 vs 1.6 ml/kg/h) before and after the implementation of IFM. During 30 days following surgery, the proportion of patients who developed one or more complications was lower in the IFM group (32 vs 48%, p<0.01). This difference was mainly explained by a significant decrease in post-operative nausea and vomiting (from 38 to 19%, p<0.01), urinary tract infections (from 9 to 1%, p<0.01) and surgical site infections (from 5 to 1%, p<0.05). Median hospital length of stay was not affected by the implementation of IFM. Conclusions In patients undergoing major spine surgery, the implementation of IFM was associated with a significant decrease in postoperative morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Che

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…2,3 Multicentre randomized controlled trials (RCTs) and meta-analyses suggest that IFM is beneficial in decreasing postoperative morbidity, shortening hospital length of stay and saving costs. [6][7][8][9][10][11] Most IFM studies have been conducted in patients undergoing major gastro-intestinal surgery . [10][11][12] A limited number of studies have been done among 3 patients undergoing orthopaedic surgery and have yielded conflicting results.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9][10][11] Most IFM studies have been conducted in patients undergoing major gastro-intestinal surgery . [10][11][12] A limited number of studies have been done among 3 patients undergoing orthopaedic surgery and have yielded conflicting results. For instance, in patients undergoing hip fracture surgery, a few studies 13,14 reported clinical benefits when using IFM, whereas others did not.…”

Section: Introductionmentioning

confidence: 99%

Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Che

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Individualized fluid management (IFM) has been shown to be useful to improve the postoperative outcome of patients undergoing major abdominal surgery. A limited number of clinical studies have been done in orthopaedic patients and have yielded conflicting results. We designed the present study to investigate the clinical impact of IFM in patients undergoing major spine surgery. Methods: This is a before-after study done in 300 patients undergoing posterior spine arthrodesis. Postoperative outcomes were compared between control group implementing standard fluid management (n = 150) and IFM group (n = 150) guided by fluid protocol based on continuous stroke volume monitoring and optimization. The primary outcome measure was the proportion of patients who developed one or more complications within 30 days following surgery.Results: During surgery, patients received on average the same volume of crystalloids (7.4 vs 7.2 ml/kg/h) and colloids (1.6 vs 1.6 ml/kg/h) before and after the implementation of IFM. During 30 days following surgery, the proportion of patients who developed one or more complications was lower in the IFM group (32 vs 48%, p<0.01). This difference was mainly explained by a significant decrease in post-operative nausea and vomiting (from 38 to 19%, p<0.01), urinary tract infections (from 9 to 1%, p<0.01) and surgical site infections (from 5 to 1%, p<0.05). Median hospital length of stay was not affected by the implementation of IFM. Conclusions: In patients undergoing major spine surgery, the implementation of IFM was associated with a significant decrease in postoperative morbidity.

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Reliability of stroke volume or pulse pressure variation as dynamic predictors of fluid responsiveness in laparoscopic surgery: a systematic review

Chen

Zhao

Zhu

2022

J Clin Monit Comput

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Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Abstract: In addition to the correspondence featured in each issue of BJA please be aware that you can submit online comments on all published articles and also submit online standalone items of correspondence too.

Cited by 7 publications

References 16 publications

Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Outcome impact of individualized fluid management during spine surgery A before-after prospective comparison study

Reliability of stroke volume or pulse pressure variation as dynamic predictors of fluid responsiveness in laparoscopic surgery: a systematic review

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