التفاصيل البيبلوغرافية
| العنوان: |
A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery. |
| المؤلفون: |
Sá Malbouisson, Luiz Marcelo1 luiz.malbouisson@hc.fm.usp.br, Silva Jr., João Manoel1, Carvalho Carmona, Maria José1, Rezende Lopes, Marcel1, Santucci Assunção, Murilo2, dos Santos Valiatti, Jorge Luís3, Marques Simões, Claudia1, Costa Auler Jr., José Otavio1 |
| المصدر: |
BMC Anesthesiology. 5/30/2017, Vol. 17, p1-10. 10p. |
| مصطلحات موضوعية: |
*CONFIDENCE intervals, *LENGTH of stay in hospitals, *INTRAOPERATIVE monitoring, *PATIENTS, *PULSE (Heart beat), *RESEARCH funding, *SURGERY, *WATER-electrolyte balance (Physiology), *DATA analysis software, *DESCRIPTIVE statistics, *SURGICAL blood loss, *ODDS ratio |
| مستخلص: |
Background: Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study. Methods: The patients were included in two periods: a first control period (control group; n = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group). We performed 1:1 propensity score matching to ensure the groups were comparable with regard to age, weight, duration of surgery, and type of operation. The primary endpoint was postoperative hospital length of stay. Results: After matching, 84 patients remained in each group. Baseline characteristics, surgical procedure duration and physiological parameters evaluated at the start of surgery were similar between the groups. The volume of crystalloids (4500 mL [3200-6500 mL] versus 5000 mL [3750-8862 mL]; P =0.01), the number of blood units infused during the surgery (1.7 U [0.9-2.0 U] versus 2.0 U [1.7-2.6 U]; P = 0.01), the fraction of patients transfused (13.1% versus 32.1%; P = 0.003) and the number of patients receiving mechanical ventilation at 24 h (3.2% versus 9.7%; P = 0.027) were smaller postoperatively in PPV group. Intraoperative PPV-based improved the composite outcome of postoperative complications OR 0.59 [95% CI 0.35-0.99] and reduced the postoperative hospital length of stay (8 days [6-14 days] versus 11 days [7-18 days]; P = 0.01). Conclusions: In high-risk surgeries, PPV-directed volume loading improved postoperative outcomes and decreased the postoperative hospital length of stay. Trial Registration: ClinicalTrials.gov Identifier; retrospectively registered- NCT03128190 [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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