Closed-loop assisted versus manual goal-directed fluid therapy during high-risk abdominal surgery: a case–control study with propensity matching View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-12

AUTHORS

Joseph Rinehart, Marc Lilot, Christine Lee, Alexandre Joosten, Trish Huynh, Cecilia Canales, David Imagawa, Aram Demirjian, Maxime Cannesson

ABSTRACT

INTRODUCTION: Goal-directed fluid therapy strategies have been shown to benefit moderate- to high-risk surgery patients. Despite this, these strategies are often not implemented. The aim of this study was to assess a closed-loop fluid administration system in a surgical cohort and compare the results with those for matched patients who received manual management. Our hypothesis was that the patients receiving closed-loop assistance would spend more time in a preload-independent state, defined as percentage of case time with stroke volume variation less than or equal to 12%. METHODS: Patients eligible for the study were all those over 18 years of age scheduled for hepatobiliary, pancreatic or splenic surgery and expected to receive intravascular arterial blood pressure monitoring as part of their anesthetic care. The closed-loop resuscitation target was selected by the primary anesthesia team, and the system was responsible for implementation of goal-directed fluid therapy during surgery. Following completion of enrollment, each study patient was matched to a non-closed-loop assisted case performed during the same time period using a propensity match to reduce bias. RESULTS: A total of 40 patients were enrolled, 5 were ultimately excluded and 25 matched pairs were selected from among the remaining 35 patients within the predefined caliper distance. There was no significant difference in fluid administration between groups. The closed-loop group spent a significantly higher portion of case time in a preload-independent state (95 ± 6% of case time versus 87 ± 14%, P =0.008). There was no difference in case mean or final stroke volume index (45 ± 10 versus 43 ± 9 and 45 ± 11 versus 42 ± 11, respectively) or mean arterial pressure (79 ± 8 versus 83 ± 9). Case end heart rate was significantly lower in the closed-loop assisted group (77 ± 10 versus 88 ± 13, P =0.003). CONCLUSION: In this case-control study with propensity matching, clinician use of closed-loop assistance resulted in a greater portion of case time spent in a preload-independent state throughout surgery compared with manual delivery of goal-directed fluid therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02020863. Registered 19 December 2013. More... »

PAGES

94

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13054-015-0827-7

DOI

http://dx.doi.org/10.1186/s13054-015-0827-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1009286356

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25888403


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295 Department of Surgery, UC Irvine Medical Center, 101 The City Drive South, 92868, Orange, CA, USA
296 rdf:type schema:Organization
 




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