Abstract
BackgroundThe aim of this study was to compare the occurrence of postoperative complications in patients undergoing elective open abdominal surgery and receiving intraoperative goal-directed hemodynamic therapy or restrictive normovolemic therapy. MethodsA total of 401 patients were randomized in the goal-directed hemodynamic therapy or restrictive normovolemic therapy groups. A cardiac output monitor was used in all goal-directed hemodynamic therapy patients and was left at the discretion of anesthetists in charge of patients in the restrictive normovolemic therapy group. The primary outcome was a composite morbidity endpoint (30-day mortality and complications grade 2–4 according to Dindo-Clavien classification). Secondary outcomes were the hospital duration of stay, the incidence of pulmonary, cardiovascular, and renal complications up to 30 days after surgery, and midterm survival. ResultsIntraoperatively, the goal-directed hemodynamic therapy group received higher intravenous fluid volumes (mean of 10.8 mL/kg/h and standard deviation of 4.0) compared with the restrictive normovolemic therapy group (mean of 7.2 mL/kg/h and standard deviation of 2.0; P < .001). On the first postoperative day, similar fluid volumes were infused in the 2 groups. The primary outcome occurred in 57.7% of goal-directed hemodynamic therapy and 53.0% of restrictive normovolemic therapy (relative risk, 1.09 [95% confidence interval, 0.91–1.30]), and there was no significant difference between groups for any secondary outcomes. ConclusionAmong patients undergoing major open abdominal surgery, the goal-directed hemodynamic therapy and the restrictive normovolemic therapy were associated with similar incidence of moderate-to-severe postoperative complications and hospital resource use.
Highlights
Fluid therapy is an important cornerstone in perioperative management, and it may influence clinical outcome and the use of health care resources, after major surgery.[1,2] Fluid overload results in interstitial edema, increased cardiorespiratory workload, and body weight gain, whereas insufficient fluid loading leads to poor peripheral blood flow and low tissue oxygen delivery
Since 2014, given concerns raised by the Committee on Pharmacovigilance Risk Assessment of the European Medicines Agency regarding the use of 6% HES in septic, burned, and critically ill patients, cardiac output (CO) optimization and compensation of fluid losses were preferably performed with crystalloids, the administration of HES was not formerly forbidden
The time course of mean arterial pressure (MAP) and cardiac index was comparable in both groups whereas toward the end of surgery, heart rate and Pulse pressure variation (PPV) increased in the restrictive normovolemic therapy (RNT) group and remained unchanged in the goal-directed hemodynamic therapy (GDHT) group (Fig 3)
Summary
Fluid therapy is an important cornerstone in perioperative management, and it may influence clinical outcome and the use of health care resources, after major surgery.[1,2] Fluid overload results in interstitial edema, increased cardiorespiratory workload, and body weight gain, whereas insufficient fluid loading leads to poor peripheral blood flow and low tissue oxygen delivery. Both strategies have been associated with impaired wound healing and poor outcomes.[3,4]. Conclusion: Among patients undergoing major open abdominal surgery, the goal-directed hemodynamic therapy and the restrictive normovolemic therapy were associated with similar incidence of moderateto-severe postoperative complications and hospital resource use
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