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 ).

scholarly journals A Prospective Comparison of TL-400 and NICOM for Goal-Directed Fluid Therapy in Gastrointestinal Tumors Surgery

2021 ◽  
Author(s):  
Min Li ◽  
Jiahui Ding ◽  
Mingqing Peng
Keyword(s):  
Fluid Therapy ◽  
Tumor Resection ◽  
Fluid Volume ◽  
Gastrointestinal Tumors ◽  
Hospital Length Of Stay ◽  
Gastrointestinal Tumor ◽  
Clinical Trial Registry ◽  
Postoperative Prognosis ◽  
Prospective Comparison ◽  
Goal Directed Fluid Therapy

Abstract Objective: Goal-directed fluid therapy (GDFT) based on NICOM(CheetahMedical, Vancouver, Washington) was highly associated with improved postoperative prognosis, but has several limitations. T-Line-400(TL-400, TensysMedical, San Diego, California) which is an emerging non-invasive hemodynamic monitor may be applicable for GDFT. Thus, the trial was to determine whether GDFT based on TL-400, when compared to GDFT based on NICOM, would lead to similar outcomes on patients undergoing gastrointestinal tumor resection.Methods: 100 patients who underwent laparoscopic resection of gastrointestinal tumors in Yongchuan Hospital of Chongqing Medical University from October 2020 to May 2021 were randomized into either TL-400 GDFT group (group T) or NICOM GDFT group (group N). The intraoperative fluid volume and the postoperative complications within 30 days were recorded.Results: There were no significantly statistical differences between groups with respect to the total fluid volume (2360 ±282ml vs 2295 ±223ml), the colloid volume (1167±153ml vs 1126±109ml), the crystalloid volume(1193 ±156ml vs 1173±157ml). Both GDFT based on TL-400 and NICOM strategies were equivalent for the first flatus(57.3±7.9 vs 58.5±8.5hours), wound healing time(11.2 ±1.2days vs 10.9±1.1days) and LOS(hospital length of stay) (13.3±1.4days vs 13.1±1.2days). In addition, the TL-400 had less data missing than the NICOM.Conclusion: TL-400 performs similarly to NICOM in guiding GDFT, with no significant differences in perioperative fluid infusion and postoperative prognosis in patients undergoing gastrointestinal tumor resection. Compared with NICOM, TL-400 can avoid the interference of electrocoagulation and can capture more data.Trial registration: This study has been registered on the Chinese Clinical Trial Registry (ChiCTR2100046350) (http://www.chictr.org.cn/index.aspx).

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

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.

E. Ulrich. On the issue of prevention and treatment of postoperative pneumonia with quinine-calcium. (Zbl. F. Ghir., 1936, 38, 2244-2247)

1937 ◽  
Vol 33 (7) ◽  
pp. 939-939
Author(s):  
B. Ivanov
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Complications ◽  
Gluteal Region ◽  
Postoperative Pneumonia ◽  
Postoperative Pulmonary Complications ◽  
Prophylactic Administration ◽  
Prevention And Treatment

Based on his observations, a. indicates that as a result of the prophylactic administration of quinine-calcium on the day of surgery and on the next two days, the frequency of postoperative pulmonary complications is reduced by about three times, and the developing complications are relatively easy (in 2/3 cases, it was only about simple bronchitis); in cases where the prophylactic administration of quinine-calcium was not produced, the vast majority of postoperative complications were pneumonia and bronchopneumonia. A. also reports on the good results of the use of quinine-calcium as a remedy for bronchitis, pneumonia and bronchopneumonia. Using Sandoz quinine calcium, as well. for prophylactic purposes, it injects it into the muscles of the gluteal region in an amount of 10 cm3 on the day of surgery, 2 times 10 cm3 the next day and another 10 cm3 on the second day after surgery.

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.

scholarly journals Application of Positive End-Expiratory Pressure (PEEP) in Patients During Prolonged Gynecological Surgery

2019 ◽  
Vol 46 (1) ◽  
pp. 28-33
Author(s):  
V. Koritarova ◽  
S. Georgiev
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Control Group ◽  
Gynecological Surgery ◽  
Ventilation Strategy ◽  
Postoperative Pulmonary Complications ◽  
Protective Ventilation Strategy ◽  
Group A ◽  
Group B

Abstract Introduction: A lot of clinical studies have shown that during prolonged surgery protective ventilation strategy, including low tidal volume, PEEP and recruitment maneuvers (RM) can reduce the rate of postoperative pulmonary complications, which are the second most common cause for postoperative mortality. Therefore, it is important to investigate clinical methods for preventing them. The strategy of protective ventilation is easy and safe for the patients and inexpensive for application during prolonged surgery. Aims: The objective of this trial was to study whether application of PEEP in patients during prolonged gynecological surgery could decrease the postoperative complications. Material and Methods: We compared the rates of postoperative complications in patients after prolonged open gynecological surgery, who were divided into 2 groups – group A, which was the control group on non-protective ventilation (35 patients) and group B on protective ventilation (35 patients). The patients in the control group were ventilated with tidal volume (VT) of 8-10 ml/kg without PEEP and RM; the patients in group B were ventilated with VT = 6-8 ml/kg according to their Predicted Body Weight, with a PEEP of 6 cm H2O and RM, which consisted of applying continuous positive airway pressure of 30 cm H2O for 30 seconds. RM was performed after intubation, after every disconnection from ventilator and before extubation. The study was successfully performed without a need for a change in the type of ventilation strategy because of hypoxia or hemodynamic instability. Statistical nonparametric test (e.g. chi-square) was applied. Results: Total rate of all postoperative complications observed in both groups was 27,1%. We found a significant relationship between application of PEEP and lower rates of postoperative pulmonary complications in group A (39,4%) compared to group B (12,1%), lower rate of respiratory failure (33,3% in group A vs. 9,1% in group B -) and atelectasis (21,2% in group A vs. 0% in group B). Conclusion: The protective ventilation strategy (low VT, PEEP and RM) in patients during prolonged gynecological surgery can reduce the rate of postoperative pulmonary complications such as respiratory failure and atelectasis.

scholarly journals Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery: a randomized clinical trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Meng-Qiu Zhang ◽  
Yu-Qi Liao ◽  
Hong Yu ◽  
Xue-Fei Li ◽  
Wei Shi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Ideal Body Weight ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Clinical Trial Registry ◽  
Elective Cardiac Surgery ◽  
Fraction Of Inspired Oxygen ◽  
Grade 3

Abstract Background To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO2) had an impact on the occurrence of postoperative pulmonary complications (PPCs). Methods A total of 413 adult patients undergoing elective cardiac surgery with CPB were randomly assigned into three groups: 138 in the NoV group (received no mechanical ventilation during CPB), 138 in the LOV group (received a tidal volume (VT) of 3–4 ml/kg of ideal body weight with the respiratory rate of 10–12 bpm, and the positive end-expiratory pressure of 5–8 cmH2O during CPB; the FiO2 was 30%), and 137 in the HOV group (received the same ventilation parameters settings as the LOV group while the FiO2 was 80%). Results The primary outcomes were the incidence and severity of PPCs during hospitalization. The composite incidence of PPCs did not significantly differ between the NoV (63%), LOV (49%) and HOV (57%) groups (P = 0.069). And there was also no difference regarding the incidence of PPCs between the non-ventilation (NoV) and ventilation (the combination of LOV and HOV) groups. The LOV group was observed a lower proportion of moderate and severe pulmonary complications (grade ≥ 3) than the NoV group (23.1% vs. 44.2%, P = 0.001). Conclusion Maintaining ventilation during CPB did not reduce the incidence of PPCs in patients undergoing cardiac surgery. Trial registration: Chinese Clinical Trial Registry ChiCTR1800015261. Prospectively registered 19 March 2018. http://www.chictr.org.cn/showproj.aspx?proj=25982

scholarly journals The Clinical Value of Pulmonary Rehabilitation in Reducing Postoperative Complications and Mortality of Lung Cancer Resection: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaowei Mao ◽  
Yiqian Ni ◽  
Yanjie Niu ◽  
Liyan Jiang
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Rehabilitation ◽  
Pulmonary Resection ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Random Regression ◽  
Postoperative Pulmonary Complications ◽  
Clinical Value ◽  
Systemic Analysis ◽  
Complications And Mortality

Background: Pulmonary rehabilitation is one meaningful way of improving exercise tolerance and pulmonary function. Thus, it may reduce the postoperative complications and mortality of pulmonary resection. Hence, we refreshed the data and conducted this systemic analysis.Method: We searched Pubmed, Web of Science, and EMBASE using “lung OR pulmonary” AND “operation OR resection OR surgery” AND “rehabilitation or exercise.” The cut-off date was September 30, 2020. The publications were filtrated, and data were extracted from all selected studies by two reviewers. Review Manger 5.1 and the fixed or random regression model were used for calculating the pooled odds ratio (OR).Result: Finally, 13 publications were enrolled in this study. Among them, five publications reported mortality, nine reported postoperative complications, and seven reported postoperative pulmonary complications. The pooled OR of mortality was 1.32 [95% confidence interval (CI): 0.54–3.23] for the pulmonary rehabilitation group, the pooled OR of postoperative complications was 0.62 (95% CI: 0.49–0.79) for the pulmonary rehabilitation group, and the pooled OR of postoperative pulmonary complications was 0.39 (95% CI: 0.27–0.56) for the pulmonary rehabilitation group. Subgroup analysis revealed the perioperative pulmonary rehabilitation was the most important part.Conclusion: Pulmonary rehabilitation may not affect the mortality of pulmonary resection patients, however, it could decrease the number of postoperative complications, especially pulmonary complications. Perioperative pulmonary rehabilitation was the most important part of the program.

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