Respiratory Exchange Ratio guided management in high-risk noncardiac surgery: The OPHIQUE multicentre randomised controlled trial.

Autor: Bar S; Department of Anaesthesiology and Critical Care Medicine, Amiens University Medical Centre, Amiens, France; SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes - Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, Amiens, France. Electronic address: stephane.bar.sb@gmail.com., Moussa MD; Department of Anaesthesiology and Critical Care Medicine, Lille University Medical Centre, Lille, France., Descamps R; Department of Anaesthesiology and Critical Care Medicine, Caen University Medical Center, Caen, France., El Amine Y; Department of Anaesthesiology and Critical Care Medicine, Valenciennes Medical Center, Valenciennes, France., Bouhemad B; Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France., Fischer MO; Department of Anaesthesiology and Critical Care Medicine, Caen University Medical Center, Caen, France; Saint Augustin Clinic, Bordeaux, France., Lorne E; Department of Anaesthesia and Critical Care Medicine, Millénaire Clinic, Montpellier, France., Dupont H; Department of Anaesthesiology and Critical Care Medicine, Amiens University Medical Centre, Amiens, France; SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes - Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, Amiens, France., Diouf M; Biostatistical Unit, Direction de la Recherche Clinique, University Hospital of Amiens Picardy, Amiens, France., Guinot PG; Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France.
Jazyk: angličtina
Zdroj: Anaesthesia, critical care & pain medicine [Anaesth Crit Care Pain Med] 2023 Aug; Vol. 42 (4), pp. 101221. Date of Electronic Publication: 2023 Mar 21.
DOI: 10.1016/j.accpm.2023.101221
Abstrakt: Background: There is a need to develop non-invasive markers to identify the occurrence of anaerobic metabolism in high-risk surgery. Our objective was to demonstrate that a goal-directed therapy algorithm incorporating the respiratory exchange ratio (ratio between CO 2 production and O 2 consumption) can reduce postoperative complications.
Methods: We conducted a randomized, multicenter, controlled clinical trial in four university medical centers and one non-university hospital from December 26, 2018, to September 9, 2021. 350 patients with a high risk of postoperative complications undergoing high-risk noncardiac surgery lasting 2 h or longer under general anesthesia were enrolled. The control group was treated according to current hemodynamic guidelines. The interventional group was treated according to an algorithm based on the measurement of the respiratory exchange ratio. The primary outcome was a composite of major complications or death within seven days of surgery. The secondary outcomes were the length of hospital stay, 30-day mortality, and the total intraoperative volume of fluids administered.
Results: The primary outcome occurred for 78 patients (45.6%) in the interventional group and 83 patients (48.8%) in the control group (relative risk: 0.93, 95% confidence interval [CI]: 0.75-1.17; p = 0.55). There were no clinically relevant differences between the two groups for secondary outcomes.
Conclusions: In high-risk surgery, a goal-directed therapy algorithm integrating the measurement of the respiratory-exchange ratio did not reduce a composite outcome of major postoperative complications or death within seven days after surgery compared to routine care.
Trial Registration: ClinicalTrials.gov, NCT03852147.
(Copyright © 2023 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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