A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery

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dc.citation.volume17
dc.contributor.authorSa Malbouisson, Luiz Marcelo
dc.contributor.authorSilva, Joao Manoel, Jr.
dc.contributor.authorCarvalho Carmona, Maria Jose
dc.contributor.authorLopes, Marcel Rezende
dc.contributor.authorAssuncao, Murilo Santucci [UNIFESP]
dc.contributor.authordos Santos Valiatti, Jorge Luis
dc.contributor.authorSimoes, Claudia Marques
dc.contributor.authorCosta Auler, Jose Otavio, Jr.
dc.coverageLondon
dc.date.accessioned2020-07-13T11:53:12Z
dc.date.available2020-07-13T11:53:12Z
dc.date.issued2017
dc.description.abstractBackground: Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study. Methods: The patients were included in two periods: a first control period (control groupen
dc.description.abstractn = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group). We performed 1:1 propensity score matching to ensure the groups were comparable with regard to age, weight, duration of surgery, and type of operation. The primary endpoint was postoperative hospital length of stay. Results: After matching, 84 patients remained in each group. Baseline characteristics, surgical procedure duration and physiological parameters evaluated at the start of surgery were similar between the groups. The volume of crystalloids (4500 mL [3200-6500 mL] versus 5000 mL [3750-8862 mL]en
dc.description.abstractP = 0.01), the number of blood units infused during the surgery (1.7 U [0.9-2.0 U] versus 2.0 U [1.7-2.6 U]en
dc.description.abstractP = 0.01), the fraction of patients transfused (13.1% versus 32.1%en
dc.description.abstractP = 0.003) and the number of patients receiving mechanical ventilation at 24 h (3.2% versus 9.7%en
dc.description.abstractP = 0.027) were smaller postoperatively in PPV group. Intraoperative PPV-based improved the composite outcome of postoperative complications OR 0.59 [95% CI 0.35-0.99] and reduced the postoperative hospital length of stay (8 days [6-14 days] versus 11 days [7-18 days]en
dc.description.abstractP = 0.01). Conclusions: In high-risk surgeries, PPV-directed volume loading improved postoperative outcomes and decreased the postoperative hospital length of stay.en
dc.description.affiliationUniv Sao Paulo, Fac Med, Hosp Clin, Div Anestesia, Av Eneas Carvalho de Aguiar,255 2 Andar, BR-05403900 Sao Paulo, SP, Brazil
dc.description.affiliationHosp Padre Albino, Catanduva Med Sch, Catanduva, SP, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Hosp Sao Paulo, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Hosp Sao Paulo, Sao Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipDIXTAL BIOMEDICA INDUSTRIA E COMERCIO LIDA
dc.format.extent-
dc.identifierhttp://dx.doi.org/10.1186/s12871-017-0356-9
dc.identifier.citationBmc Anesthesiology. London, v. 17, p. -, 2017.
dc.identifier.doi10.1186/s12871-017-0356-9
dc.identifier.fileWOS000402593400001.pdf
dc.identifier.issn1471-2253
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/54448
dc.identifier.wosWOS:000402593400001
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofBmc Anesthesiology
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectGoal-directed fluid therapyen
dc.subjectHemodynamicsen
dc.subjectHigh-risk surgeryen
dc.subjectPulse-pressure variationen
dc.subjectPostoperative complicationsen
dc.titleA pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgeryen
dc.typeinfo:eu-repo/semantics/article
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