Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery

A multi-center, prospective, randomized study

Cornelie Salzwedel, Jaume Puig, Arne Carstens, Berthold Bein, Z. Molnár, Krisztian Kiss, Ayyaz Hussain, Javier Belda, Mikhail Y. Kirov, Samir G. Sakka, Daniel A. Reuter

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Introduction: Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG). Methods: 160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively. Results: The total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929). Conclusions: This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery. Trial registration: ClinicalTrial.gov, NCT01401283.

Original languageEnglish
Article numberR191
JournalCritical Care
Volume17
Issue number5
DOIs
Publication statusPublished - Sep 8 2013

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Arterial Pressure
Hemodynamics
Prospective Studies
Blood Pressure
Control Groups
Length of Stay
Group Psychotherapy
Therapeutics
Radial Artery
Pulse
Meta-Analysis
Anesthesia
Infection

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

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Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery : A multi-center, prospective, randomized study. / Salzwedel, Cornelie; Puig, Jaume; Carstens, Arne; Bein, Berthold; Molnár, Z.; Kiss, Krisztian; Hussain, Ayyaz; Belda, Javier; Kirov, Mikhail Y.; Sakka, Samir G.; Reuter, Daniel A.

In: Critical Care, Vol. 17, No. 5, R191, 08.09.2013.

Research output: Contribution to journalArticle

Salzwedel, Cornelie ; Puig, Jaume ; Carstens, Arne ; Bein, Berthold ; Molnár, Z. ; Kiss, Krisztian ; Hussain, Ayyaz ; Belda, Javier ; Kirov, Mikhail Y. ; Sakka, Samir G. ; Reuter, Daniel A. / Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery : A multi-center, prospective, randomized study. In: Critical Care. 2013 ; Vol. 17, No. 5.
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T2 - A multi-center, prospective, randomized study

AU - Salzwedel, Cornelie

AU - Puig, Jaume

AU - Carstens, Arne

AU - Bein, Berthold

AU - Molnár, Z.

AU - Kiss, Krisztian

AU - Hussain, Ayyaz

AU - Belda, Javier

AU - Kirov, Mikhail Y.

AU - Sakka, Samir G.

AU - Reuter, Daniel A.

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N2 - Introduction: Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG). Methods: 160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively. Results: The total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929). Conclusions: This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery. Trial registration: ClinicalTrial.gov, NCT01401283.

AB - Introduction: Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG). Methods: 160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively. Results: The total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929). Conclusions: This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery. Trial registration: ClinicalTrial.gov, NCT01401283.

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