Document Detail


Haemodynamic optimisation in lower limb arterial surgery: room for improvement?
MedLine Citation:
PMID:  22946700     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Goal-directed therapy has been proposed to improve outcome in high-risk surgery patients. The aim of this study was to investigate whether individualised goal-directed therapy targeting stroke volume and oxygen delivery could reduce the number of patients with post-operative complications and shorten hospital length of stay after open elective lower limb arterial surgery.
METHODS: Forty patients scheduled for open elective lower limb arterial surgery were prospectively randomised. The LiDCO™plus system was used for haemodynamic monitoring. In the intervention group, stroke volume index was optimised by administering 250 ml aliquots of colloid intraoperatively and during the first 6 h post-operatively. Following surgery, fluid optimisation was supplemented with dobutamine, if necessary, targeting an oxygen delivery index level ≥ 600 ml/min(/) m(2) in the intervention group. Central haemodynamic data were blinded in control patients. Patients were followed up after 30 days.
RESULTS: In the intervention group, stroke volume index, and cardiac index were higher throughout the treatment period (45 ± 10 vs. 41 ± 10 ml/m(2), P < 0.001, and 3.19 ± 0.73 vs. 2.77 ± 0.76 l/min(/) m(2), P < 0.001, respectively) as well as post-operative oxygen delivery index (527 ± 120 vs. 431 ± 130 ml/min(/) m(2), P < 0.001). In the same group, 5/20 patients had one or more complications vs. 11/20 in the control group (P = 0.05). After adjusting for pre-operative and intraoperative differences, the odds ratio for ≥ 1 complications was 0.18 (0.04-0.85) in the intervention group (P = 0.03). The median length of hospital stay did not differ between groups.
CONCLUSION: Perioperative individualised goal-directed therapy may reduce post-operative complications in open elective lower limb arterial surgery.
Authors:
J Bisgaard; T Gilsaa; E Rønholm; P Toft
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-09-04
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  57     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-08     Completed Date:  2013-06-17     Revised Date:  2013-08-27    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  189-98     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.
Affiliation:
Department of Anaesthesia and Intensive Care, Lillebaelt Hospital Kolding, Kolding, Denmark. janniebisgaard@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Arteries / surgery*
Blood Pressure / physiology
Blood Volume / physiology
Colloids / therapeutic use
Female
Fluid Therapy
Heart Rate / physiology
Hemodynamics / physiology*
Humans
Individualized Medicine
Length of Stay
Lower Extremity / surgery*
Male
Middle Aged
Monitoring, Intraoperative
Oxygen / blood
Plasma Substitutes / therapeutic use
Prospective Studies
Stroke Volume / physiology
Vascular Surgical Procedures / methods*
Chemical
Reg. No./Substance:
0/Colloids; 0/Plasma Substitutes; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Acta Anaesthesiol Scand. 2013 Aug;57(7):946   [PMID:  23530779 ]
Acta Anaesthesiol Scand. 2013 Aug;57(7):946-7   [PMID:  23750617 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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