| A prospective randomized trial of preoperative "optimization" of cardiac function in patients undergoing elective peripheral vascular surgery. | |
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MedLine Citation:
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PMID: 9308617 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Previous investigations have suggested that preoperative invasive hemodynamic monitoring with "optimization" of cardiovascular function may favorably affect the outcome among patients undergoing peripheral vascular surgery. The purpose of this study was to evaluate the effect of preoperative optimization of hemodynamic parameters on outcome in patients undergoing aortic reconstruction (AR) or limb salvage procedures (LSP) in a randomized, prospective clinical trial. METHODS: All 72 patients who consented to participate in this study were admitted to the intensive care unit at least 12 hours before operation for placement of a pulmonary artery catheter (PAC). Patients who were randomized to the treatment group (n = 32) were "optimized" by adjusting their hemoglobin concentration, oxygen saturation (SaO2), cardiac output, or afterload until the mixed venous O2 saturation (SvO2) was at least 65%. The control group (n = 40) underwent placement of a PAC and had oxygen transport parameters measured without any attempt to optimize SvO2. RESULTS: There were no significant differences between the treatment and control groups with respect to age, gender, type of operation, initial Acute Physiology and Chronic Health Evaluation (APACHE) II score, SvO2, pulmonary artery occlusion pressure, or cardiac index. All treatment patients achieved an SvO2 of at least 65% before operation. Comparing the treatment and control groups, postoperative cardiovascular complications occurred in 25% versus 27%, intraoperative complications in 28% versus 20%, and death in 9% versus 5%, respectively. None of these differences was statistically significant as a whole or within the subgroups undergoing AR or LSP. CONCLUSIONS: These data suggest that preoperative optimization of cardiovascular function by using achievement of SvO2 above 65% as the end point does not result in any reduction of intraoperative or perioperative cardiac complications in patients undergoing PVS. Further studies with alternative assessments and manipulation of different cardiopulmonary parameters may yield additional information. |
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Authors:
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D W Ziegler; J G Wright; P S Choban; L Flancbaum |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Surgery Volume: 122 ISSN: 0039-6060 ISO Abbreviation: Surgery Publication Date: 1997 Sep |
Date Detail:
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Created Date: 1997-10-23 Completed Date: 1997-10-23 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 584-92 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Ohio State University College of Medicine, Columbus, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Female Heart / physiopathology* Hemodynamics Humans Intensive Care* Intraoperative Complications Male Middle Aged Osmolar Concentration Oxygen / blood Postoperative Complications Preoperative Care* Prospective Studies Survival Analysis Vascular Surgical Procedures* Veins |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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Surgery. 1998 Jun;123(6):719-20
[PMID:
9626327
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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