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Open Access 01-10-2013 | Research

Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

Authors: Cornelie Salzwedel, Jaume Puig, Arne Carstens, Berthold Bein, Zsolt Molnar, Krisztian Kiss, Ayyaz Hussain, Javier Belda, Mikhail Y Kirov, Samir G Sakka, Daniel A Reuter

Published in: Critical Care | Issue 5/2013

Abstract

Introduction

Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).

Methods

160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.

Results

The total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).

Conclusions

This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.

Trial registration

ClinicalTrial.gov, NCT01401283.

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Title: Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study
Authors: Cornelie Salzwedel
Jaume Puig
Arne Carstens
Berthold Bein
Zsolt Molnar
Krisztian Kiss
Ayyaz Hussain
Javier Belda
Mikhail Y Kirov
Samir G Sakka
Daniel A Reuter
Publication date: 01-10-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc12885

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Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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