scholarly journals Goal-directed fluid therapy in urgent GAstrointestinal Surgery—study protocol for A Randomised multicentre Trial: The GAS-ART trial

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022651
Author(s):  
Anders Winther Voldby ◽  
Anne Albers Aaen ◽  
Ann Merete Møller ◽  
Birgitte Brandstrup
Keyword(s):  
Mechanical Ventilation ◽  
Gastrointestinal Tract ◽  
Postoperative Complications ◽  
Fluid Therapy ◽  
Bowel Disease ◽  
Gastrointestinal Surgery ◽  
Postoperative Mortality ◽  
Bleeding Complications ◽  
Standard Group ◽  
Goal Directed Fluid Therapy

IntroductionIntravenous fluid therapy during gastrointestinal surgery is a life-saving part of the perioperative care. Too little fluid may lead to hypovolaemia, decreased organ perfusion and circulatory shock. Excessive fluid administration increases postoperative complications, worsens pulmonary and cardiac function as well as the healing of surgical wounds. Intraoperative individualised goal-directed fluid therapy (GDT) and zero-balance therapy (weight adjusted) has shown to reduce postoperative complications in elective surgery, but studies in urgent gastrointestinal surgery are sparse. The aim of the trial is to test whether zero-balance GDT reduces postoperative mortality and major complications following urgent surgery for obstructive bowel disease or perforation of the gastrointestinal tract compared with a protocolled standard of care.Methods/analysisThis study is a multicentre, randomised controlled trial with planned inclusion of 310 patients. The randomisation procedure is stratified by hospital and by obstructive bowel disease and perforation of the gastrointestinal tract. Patients are allocated into either ‘the standard group’ or ‘the zero-balance GDT group’. The latter receive intraoperative GDT (guided by a stroke volume algorithm) and postoperative zero-balance fluid therapy based on body weight and fluid charts. The protocolled treatment continues until free oral intake or the seventh postoperative day.The primary composite outcome is death, unplanned reoperations, life-threatening thromboembolic and bleeding complications, a need for mechanical ventilation or dialysis. Secondary outcomes are additional complications, length of hospital stay, length of stay in the intensive care unit, length of mechanical ventilation, readmissions and time to death. Follow-up is 90 days.We plan intention-to-treat analysis of the primary outcome.Ethics and disseminationThe Danish Scientific Ethics Committee approved the GAS-ART trial before patient enrolment (J: SJ-436). Enrolment of patients began in August 2015 and is proceeding. We expect to publish the GAS-ART results in Summer 2019.Trial registration numberEudraCT 2015-000563-14.

Is goal-directed fluid therapy beneficial for gastrointestinal surgery within an enhanced recovery program? A systematic review and meta-analysis

2020 ◽  
Keyword(s):  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Postoperative Morbidity ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Gastrointestinal Surgery ◽  
Postoperative Mortality ◽  
Current Evidence ◽  
Anastomotic Leaks ◽  
Goal Directed Fluid Therapy

Objectives: To systematically evaluate the clinical effect of intraoperative goal-directed fluid therapy (GDFT) in gastrointestinal surgery within an enhanced recovery after surgery (ERAS) program. Methods: EMBASE, MEDLINE, Cochrane Library, PubMed, OVID, CNKI and other databases were searched for randomized controlled trials (RCTs) from the inception dates to December 2018. These studies included patients undergoing elective gastrointestinal surgery comparing regular fluid therapy versus GDFT within ERAS. The meta-analysis was carried on with RevMan 5.3. Results: A total of 10 RCT studies were included with 1216 patients. Compared with the regular fluid therapy group, the GDFT group reduced the rate of readmission [odds ratio, OR = 1.67, 95% CI (1.05, 2.65), P = 0.03] in gastrointestinal surgery patients within ERAS. However, there was no significant decrease in length of hospital stay (LOHS) [mean difference, MD = -0.11, 95% CI (-1.22, 1.00), P = 0.85], postoperative morbidity [OR = 0.78, 95% CI (0.55, 1.11), P = 0.17], postoperative mortality [OR = 0.86, 95% CI (0.30, 2.49), P = 0.78], postoperative ileus [OR = 1.24, 95% CI (0.70, 2.19), P = 0.45], anastomotic leaks [OR= 0.66, 95% CI (0.29, 1.49), P = 0.31] and the first gastrointestinal motility time [MD = -0.37, 95% CI (-1.07, 0.33), P = 0.30]. Conclusions: The current evidence demonstrates that, in gastrointestinal surgery within ERAS, GDFT decreased the rate of readmission. However, there was no advantage over regular fluid therapy in the reduction of LOHS, postoperative morbidity, postoperative mortality, postoperative ileus and anastomotic leaks.

scholarly journals Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xia Liu ◽  
Peng Zhang ◽  
Meng Xue Liu ◽  
Jun Li Ma ◽  
Xin Chuan Wei ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Randomized Controlled ◽  
Carbohydrate Loading ◽  
Prospective Randomized Controlled Trial ◽  
Preoperative Carbohydrate Loading ◽  
Goal Directed Fluid Therapy

Abstract Background The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery. Methods This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded. Results Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p < 0.001) and produced significantly less urine output (200 ml [150–300] vs 400 ml [290–500]; p < 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h; p = 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h; p = 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients; p = 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p > 0.05). Conclusions Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered.

scholarly journals Preoperative Carbohydrate Load and Intraoperative Goal-Directed Fluid Therapy for Elderly Patients Undergoing Open Gastrointestinal Operation: A Prospective Randomized Controlled Trial

2020 ◽  
Author(s):  
Xia Liu ◽  
Peng Zhang ◽  
MengXue Liu ◽  
JunLi Ma ◽  
XinChuan Wei ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Anesthesia Induction ◽  
Randomized Controlled ◽  
Goal Directed Fluid Therapy ◽  
Fluid Optimisation

Abstract Background: At present it remains uncertain as to whether carbohydrate (200 ml) loaded 2 hours before anesthesia induction combined with intraoperative goal-directed fluid therapy (GDFT) is beneficial to elderly patients undergoing gastrointestinal operations. As such, a randomized controlled trial was designed to evaluate the relative impact of perioperative fluid optimisation versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.Methods: A total of 120 elderly patients undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) load 2 hours before anesthesia induction. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic information, intraoperative parameters and postoperative outcomes were recorded.Results: Patients in the GDFT group were administered less crystalloid fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p = 0.000) and produced less urine output (200 ml [150-300] vs 400 ml [290-500]; p = 0.000) relative to patients in the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (55 ± 13.9 hours vs 65 ± 22.6 hours; p = 0.004) and oral intake (72 ± 17.4 hours vs 85 ± 27.5 hours; p = 0.002), as well as a reduction in the rate of postoperative complications (14 (25.5%) vs 27(47.4%) patients; p = 0.016). However, postoperative hospitalization or hospitalization expenses were similar between groups.Conclusions: Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration: ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=29899

scholarly journals ELECTROSURGICAL AND ULTRASOUND DISSECTION AND COAGULATION TISSUE EFFECT FEATURES DURING OPERATIONS ON STOMACH AND INTESTINES

2018 ◽  
Keyword(s):  
Gastrointestinal Tract ◽  
Postoperative Complications ◽  
Blood Vessels ◽  
Postoperative Mortality ◽  
Main Group ◽  
Ultrasound Scanning ◽  
Results Of Treatment ◽  
Tissue Effect ◽  
Ultrasound Dissection

The work is devoted to the problem of reducing intra- and postoperative complications in patients with surgical gastrointestinal tract pathology. The aim of the study is to comprehensively investigate electrosurgical and ultrasound dissection and coagulation features to prevent intra- and postoperative complications, improve the results of treatment of patients with surgical gastrointestinal tract pathology. The study included experimental and clinical parts. The use of ultrasound scanning in the main group of patients revealed significant advantages of this method compared to MES. This device allowed not only to carry out the dissection of the gastrointestinal tract organs, but also to mobilize them, thereby simplifying and speeding up the operation. Intersection of vessels of both omenta, small and large intestines mesentery vessels was carried out with alternating regimes of coagulation and cutting, while ligating only large blood vessels. The study showed that thanks to the use of ultrasound scanning it was possible to reduce the number of postoperative complications from 16.2% to 6.7%, postoperative mortality decreased from 6.11% to 1.55%, and postoperative bed-day decreased from an average of 17.5+ 3.75 to 12.5 + 2.58, which in the complex allowed to improve the parameters of treatment and rehabilitation of patients.

scholarly journals Goal-directed fluid therapy does not reduce postoperative ileus in gastrointestinal surgery

Medicine ◽  
2018 ◽  
Vol 97 (45) ◽  
pp. e13097 ◽  
Author(s):  
Xiongxin Zhang ◽  
Wei Zheng ◽  
Chaoqin Chen ◽  
Xianhui Kang ◽  
Yueying Zheng ◽  
...  
Keyword(s):  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Gastrointestinal Surgery ◽  
Goal Directed Fluid Therapy

scholarly journals Diagnosis and Treatment of Obturator Hernia: Retrospective Analysis of 86 Clinical Cases at a Single Institution.

2020 ◽  
Author(s):  
ZHENGZHENG LI ◽  
Chaoyang Gu ◽  
Mingtian Wei ◽  
Xing Yuan ◽  
Ziqiang Wang
Keyword(s):  
Postoperative Complications ◽  
Emergency Surgery ◽  
Bowel Resection ◽  
Elective Surgery ◽  
Gastrointestinal Surgery ◽  
Intestinal Resection ◽  
Postoperative Mortality ◽  
Obturator Hernia ◽  
Diagnosis And Treatment ◽  
Surgery Group

Abstract Background: To explore the clinical characteristics, diagnosis and treatment of obturator hernia.Methods: Eighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed, and the patients were followed by telephone or clinic visit to check for the recurrence.Results: 30 days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients(24/59, 40.7%). There were 4 deaths(4/59, 6.8%) in this group ,all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3 -year recurrence rates of 5.1% (3/59)and 7.1%(1/14) were observed in the emergency surgery and the elective surgery group, respectively. Conclusions: CT examination plays an important role in improving the diagnostic rate of obturator hernia. In elderly people with comorbidities, timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, postoperative mortality is significantly associated with bowel resection and postoperative complications.

scholarly journals Prospective comparison of the effects of intraoperative goal-directed fluid therapy and restrictive fluid therapy on complications in thoracoscopic lobectomy

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110627
Author(s):  
Min Li ◽  
Mingqing Peng
Keyword(s):  
Postoperative Complications ◽  
Fluid Therapy ◽  
Therapy Group ◽  
Pulmonary Complications ◽  
Fluid Volume ◽  
Postoperative Pulmonary Complications ◽  
Clinical Trial Registry ◽  
Thoracoscopic Lobectomy ◽  
Prospective Comparison ◽  
Goal Directed Fluid Therapy

Objective Restrictive fluid therapy is recommended in thoracoscopic lobectomy to reduce postoperative pulmonary complications, but it may contribute to hypovolemia. Goal-directed fluid therapy (GDFT) regulates fluid infusion to an amount required to avoid dehydration. We compared the effects of GDFT versus restrictive fluid therapy on postoperative complications after thoracoscopic lobectomy. Methods In total, 124 patients who underwent thoracoscopic lobectomy were randomized into the GDFT group (group G, n = 62) or restrictive fluid therapy group (group R, n = 62). The fluid volume and postoperative complications within 30 days of surgery were recorded. Results The total fluid volume in groups G and R was 1332 ± 364 and 1178 ± 278 mL, respectively. Group R received a smaller colloid fluid volume (523 ± 120 vs. 686 ± 180 mL), had a smaller urine output (448 ± 98 vs. 491 ± 101 mL), and received more norepinephrine (120 ± 66 vs. 4 ± 18 µg) than group G. However, there were no significant differences in postoperative pulmonary complications, acute kidney injury, length of hospital stay, or in-hospital mortality between the two groups. Conclusion Restrictive fluid therapy performs similarly to GDFT in thoracoscopic lobectomy but is a simpler fluid strategy than GDFT. Trial registration: This study has been registered at the Chinese Clinical Trial Registry (ChiCTR2100051339) ( http://www.chictr.org.cn/index.aspx ).

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