Kramer, A (2017) The evaluation of intraoperative hemodynamic monitoring and a goal-directed fluid therapy optimization protocol in patients undergoing highrisk surgery to improve postoperative outcome. thesis, Medicine.
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Abstract
Abstract Introduction. Patients undergoing high-risk surgery have an increased risk of postoperative morbidity, mortality and prolonged ICU and hospital stay. Literature shows that perioperative goal-directed fluid therapy (GDFT) may improve these postoperative outcomes. In 2012 a multicenter randomized controlled trial (RCT) was started, the Early Goal-directed therapy trial (EGDT). The primary aim of the RCT was to examine whether a SVV- and CI-guided GDFT-protocol reduces the postoperative complications rate in high-risk surgery (HRS) patients. Materials and Methods. In this trial, we studied the beneficial effects of the implemented GDFT-protocol in the UMCG using stroke volume variation (SVV) and cardiac index (CI) on postoperative outcome. Included HRS procedures were: open esophagus resection, pylorus preserving pancreaticoduodenectomy (PPPD), open abdominal aortic aneurysm (AAA) repair and other soft tissue resections due to malignancy. More procedures were included if the ASA physiologic score was higher than 3, these included: gastrectomy, colorectal resections and other abdominal procedures. Perioperative monitoring of SVV and CI using the EV1000 Clinical Platform/Flotrac hemodynamic monitoring system was used to guide intravenous fluid administration. Patients were allocated into two groups. One group received the standard fluid administration (n=40) and the other the standard care plus the GDFT-protocol (n=47). The primary outcome measure in this study was the length of ICU stay as measured by the Fit For Discharge score. Secondary outcomes included the SOFA-, TISS-, Fit For Discharge Delay score and total length of hospitalization. Results. There were no significant differences in age, gender, length of procedure, body surface area and ASA score between the intervention and standard care group. The SOFA-score did not show significant differences between both groups, however a trend of a higher SOFA-score was seen with HRS patients undergoing PPPD after implementation of the protocol. In HRS patients undergoing esophagus resections, PPPD and soft tissue resections due to malignancy the TISS-score showed a tendency to decrease when the protocol was implemented. The cumulative reduction was 15% after implementation. The Fit For Discharge did not show a difference between the groups. A significant decrease in the Fit For Discharge Delay score was seen after implementation in the group of patients undergoing PPPD, it showed a reduction of 11 hours (or 74%), p=0,022. Conclusion. To conclude, this study shows that the implementation of a SVV- and CI-guided GDFT-protocol in the perioperative period might have a beneficial effect on the TISS-score, Fit For Discharge score, total admission time on the ICU, the Fit For Discharge delay score and the total hospitalization of high-risk surgical patients in this medical center. Patients undergoing a PPPD procedure seem to benefit most from the GDFT-protocol, showing a Fit For Discharge Delay score that was reduced significantly. More research is needed to investigate these effects further, by enlarging the sample size.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Scheeren, Prof. dr. T.W.L and Department of Anesthesiology, Universal Medical Center Groni |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2484 |
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