Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacementReportar como inadecuado




Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Anesthesiology

, 15:148

First Online: 15 October 2015Received: 15 December 2014Accepted: 07 October 2015

Abstract

BackgroundThe use of goal directed fluid protocols in intermediate risk patients undergoing hip or knee replacement was studied in few trials using invasive monitoring. For this reason we have implemented two different fluid management protocols, both based on a novel totally non-invasive arterial pressure monitoring device and compared them to the standard no-protocol treatment applied before the transition in our academic institution.

MethodsThree treatment groups were compared in this prospective study: the observational CONTROL, N = 40 group before adoption of fluid protocols and two randomized groups after the transition to protocol fluid management with the use of the continuous non-invasive blood pressure monitoring CNAP® device. In the PRESSURE group N = 40 standard variables were used for restrictive fluid therapy. Goal directed fluid therapy using pulse pressure variation was used in the GDFT arm N = 40. The influence on the rate of postoperative complications, on the hospital length of stay and other parameters was assessed.

ResultsBoth protocols were associated with decreased fluid administration and maintained hemodynamic stability. Reduced rate of postoperative infection and organ complications 22 55 % vs. 33 83 % patients; p = 0.016; relative risk 0.67 0.49–0.91 was observed in the GDFT group compared to CONTROL. Lower number of patients receiving transfusion 4 10 % in GDFT vs. 17 43 % in CONTROL; p = 0.005 might contribute to this observation. No significant differences were observed in other end-points.

ConclusionIn our study, the use of the fluid protocol based on pulse pressure variation assessed using continuous non-invasive arterial pressure measurement seems to be associated with a reduction in postoperative complications and transfusion needs as compared to standard no-protocol treatment.

Trial registrationACTRN12612001014842

KeywordsFluid management Perioperative care Goal directed therapy Pulse pressure variation AbbreviationsASAAmerican Society of Anesthesiology physical status

CNAPContinuous Non-invasive Arterial Pressure name of the device

CONTROLName of the prospective observational group

GDFTName of the randomized group with fluid management based on pulse pressure variation

GDTGoal-directed therapy

GITGastro-intestinal tract

HRHeart rate

ICUIntensive Care Unit

MACMinimal alveolar concentration

MAPMean arterial pressure

PPVPulse pressure variation

PONVPostoperative nausea and vomiting

PRESSUREName of the randomized group based on standard fluid management

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12871-015-0131-8 contains supplementary material, which is available to authorized users.

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Autor: Jan Benes - Lenka Haidingerova - Jiri Pouska - Jan Stepanik - Alena Stenglova - Jan Zatloukal - Richard Pradl - Ivan Chytr

Fuente: https://link.springer.com/







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