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01-03-2018 | Original Article

Reduction of Cardiopulmonary/Renal Complications with Serum BNP-Guided Volume Status Management in Posthepatectomy Patients

Authors: Sameer H. Patel, Bradford J. Kim, Ching-Wei D. Tzeng, Yun Shin Chun, Claudius Conrad, Jean-Nicolas Vauthey, Thomas A. Aloia

Published in: Journal of Gastrointestinal Surgery | Issue 3/2018

Abstract

Background

After hepatectomy, over- and under-resuscitations induce cardiopulmonary complications and acute kidney injury, respectively, leading to significant perioperative morbidity and mortality. Unlike serum chemistries or urine output, serum brain natriuretic peptide (BNP) levels have been shown to accurately reflect current intravascular fluid balance without influence from alterations of hormonal axes. Based on these data, this study was designed to measure the impact of a serum BNP-guided hepatobiliary fluid protocol on the incidence of posthepatectomy cardiopulmonary/renal complications.

Methods

Hepatectomy patients registered in a single-institution American College of Surgeons-National Surgical Quality Improvement Program database between 2011 and 2016 were examined in real time for the development of cardiopulmonary/renal complications and divided into pre- (2011–2013) and postimplementation (2014–2016) of a BNP-guided hepatobiliary fluid protocol groups. In the postimplementation group, maintenance fluids were tapered on a set protocol. Bolus fluids, diuresis, and micro-adjustments in fluid rate were guided by daily BNP values.

Results

Four hundred sixty patients underwent hepatectomy in the study period with 251 patients in the pre- and 209 patients in the postprotocol implementation groups. Cardiopulmonary/renal complication rates were 4.0% in the preprotocol group and reduced to 0.9% after initiation of the BNP-guided hepatobiliary fluid protocol (p = 0.04).

Conclusions

Despite low event rates, these data suggest that goal-directed postoperative fluid therapy with the combination of a hepatobiliary fluid protocol and serum BNP-guided volume management is superior to traditional chemistry and bedside volume assessment and can reduce posthepatectomy cardiopulmonary and renal complications.

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Title: Reduction of Cardiopulmonary/Renal Complications with Serum BNP-Guided Volume Status Management in Posthepatectomy Patients
Authors: Sameer H. Patel
Bradford J. Kim
Ching-Wei D. Tzeng
Yun Shin Chun
Claudius Conrad
Jean-Nicolas Vauthey
Thomas A. Aloia
Publication date: 01-03-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 3/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3600-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Reduction of Cardiopulmonary/Renal Complications with Serum BNP-Guided Volume Status Management in Posthepatectomy Patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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