Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery
Publication Type:Journal Article
Source:Indian Journal of Anaesthesia, Indian Society of Anaesthetists, Volume 59, Number 4, p.228-233 (2015)
Keywords:abdominal surgery, anastomosis leakage, arterial pressure, article, artificial ventilation, blood gas analysis, central venous pressure, clinical article, heart arrhythmia, heart index, hemoglobin, hospitalization, human, hypothermia, intensive care unit, Lactic acid, outcome assessment, oxygen extraction fraction, oxygen saturation, paralytic ileus, prospective study, wound
Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT) targeting cardiac index (CI) and oxygen extraction ratio (O<inf>2</inf> ER) on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III) undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8–10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT), in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m2 and O<inf>2</inf> ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU) and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05). The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05). There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days) or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days) between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation. © 2015, Indian Journal of Anaesthesia. All right reserved.
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