Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study.
| Autor: | Le Guen, Morgan, Le Gall-Salaun, Amandine, Josserand, Julien, Gaudin de Vilaine, Augustin, Viquesnel, Simon, Muller, Damien, Rozec, Bertrand, Billet, Kévin Buffenoir, Cinotti, Raphaël, the Société Française d'Anesthésie-Réanimation–SFAR Research Network, Yavchitz, Amélie, Sigault, Stéphanie, Mazereaud, Aurélien, Bezu, Lucilia, Léger, Maxime, Evain, Jean-Noël |
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| Předmět: |
BRAIN tumor diagnosis
ELECTIVE surgery RESEARCH PNEUMONIA FLUID therapy NEUROSURGERY TIME INTRACRANIAL hemorrhage SURGICAL complications RETROSPECTIVE studies BRAIN tumors NOSOCOMIAL infections ARTIFICIAL respiration HOSPITAL mortality GLASGOW Coma Scale SURGICAL site infections DESCRIPTIVE statistics CRANIOTOMY PSYCHOMOTOR disorders SEIZURES (Medicine) ARRHYTHMIA DATA analysis software GOAL (Psychology) INTRACRANIAL hypertension |
| Zdroj: | BMC Anesthesiology; 1/13/2023, Vol. 23 Issue 1, p1-7, 7p |
| Abstrakt: | Background: Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods: We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size ≥ 35 mm and/or mid-line shift ≥ 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation ≥ 48 h and in-hospital mortality. Results: From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05). Conclusions: In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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