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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2016 November;82(11):1158-69
Non-invasive hemodynamic optimization in major abdominal surgery: a feasibility study
Ole BROCH 1, Arne CARSTENS 2, Matthias GRUENEWALD 1, Edith NISCHELSKY 3, Lukas VELLMER 3, Berthold BEIN 4, Heiko ASELMANN 5, Markus STEINFATH 1, Jochen RENNER 1 ✉
1 Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany; 2 Department of Anesthesiology and Intensive Care Medicine, Imland Hospital, Rendsburg, Germany; 3 Christian-Albrechts-University Kiel, Schleswig-Holstein, Germany; 4 Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany; 5 Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
BACKGROUND: Today, most of the pre-emptive hemodynamic optimization algorithms are based on variables associated with invasive techniques like arterial cannulation. The non-invasive Nexfin™ technology is able to estimate continuous Cardiac Index (CI) and pulse pressure variation (PPV). However, the efficiency of an early goal directed therapy (EGDT) algorithm based on non-invasive variables has to be proven. The aim of our study was to investigate the feasibility of a non-invasive driven EGDT protocol and its impact on patient’s outcome.
METHODS: Seventy-nine patients (ASA II-III) undergoing elective major abdominal surgery were randomized to either study group (SG, N.=39) or control group (CG, N.=40). The SG was treated according to an algorithm based on non-invasive CI and PPV, whereas the CG received standard of care. Postoperative complications up to 28 days and length of hospital stay (LOS) in both groups were recorded.
RESULTS: There was no significant difference between the groups regarding demographics, hemodynamic variables, preoperative risk scores and duration of surgery. The total amount of complications was higher in the CG (SG 94 vs. CG 132 complications, P=0.22) without reaching statistical significance. LOS revealed no difference between both groups (SG, 9 [7-15] vs. CG, 9 [7-15.25] days, P=0.82). We have seen no impact of the non-invasive optimization protocol with respect to postoperative mortality.
CONCLUSIONS: In this patient collective, we could demonstrate the feasibility of a non-invasive approach for hemodynamic optimization. However, EGDT based on non-invasive variables was not able to significantly improve outcome.