Abstract
IntroductionSeveral studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome. This goal could be achieved simply by minimizing the variation in arterial pulse pressure (ΔPP) induced by mechanical ventilation. We tested this hypothesis in a prospective, randomized, single-centre study. The primary endpoint was the length of postoperative stay in hospital.MethodsThirty-three patients undergoing high-risk surgery were randomized either to a control group (group C, n = 16) or to an intervention group (group I, n = 17). In group I, ΔPP was continuously monitored during surgery by a multiparameter bedside monitor and minimized to 10% or less by volume loading.ResultsBoth groups were comparable in terms of demographic data, American Society of Anesthesiology score, type, and duration of surgery. During surgery, group I received more fluid than group C (4,618 ± 1,557 versus 1,694 ± 705 ml (mean ± SD), P < 0.0001), and ΔPP decreased from 22 ± 75 to 9 ± 1% (P < 0.05) in group I. The median duration of postoperative stay in hospital (7 versus 17 days, P < 0.01) was lower in group I than in group C. The number of postoperative complications per patient (1.4 ± 2.1 versus 3.9 ± 2.8, P < 0.05), as well as the median duration of mechanical ventilation (1 versus 5 days, P < 0.05) and stay in the intensive care unit (3 versus 9 days, P < 0.01) was also lower in group I.ConclusionMonitoring and minimizing ΔPP by volume loading during high-risk surgery improves postoperative outcome and decreases the length of stay in hospital.Trial registrationNCT00479011
Highlights
IntroductionSeveral studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome
Several studies have shown that maximizing stroke volume by volume loading during high-risk surgery may improve post-operative outcome
In patients operating on the flat portion of the Frank-Starling curve, ΔPP is low, and volume loading does not result in a significant increase in stroke volume [6]
Summary
Several studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome This goal could be achieved by minimizing the variation in arterial pulse pressure (ΔPP) induced by mechanical ventilation. Several reports [1,2,3,4] have shown that monitoring and maximizing stroke volume by volume loading during high-risk surgery decreases the incidence of postoperative complications and the length of stay in the intensive care unit (ICU) and in the hospital This strategy has so far required the measurement of stroke volume by a cardiac output monitor as well as a specific training period for the operators [5]. The clinical and intraoperative goal of 'maximizing stroke volume by volume loading' can be achieved by minimizing ΔPP [12]
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