Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery

Autor: Geerard L. Beets, H. M. Willigers, Wim A. Buurman, M.F. von Meyenfeldt, Jochen Jansen, Kostan W. Reisinger, Martijn Poeze
Přispěvatelé: MUMC+: MA AIOS Heelkunde (9), MUMC+: MA Anesthesiologie (9), Surgery, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: MA Heelkunde (9), MUMC+: TPZ Netwerk Acute Zorg Limburg (9), RS: NUTRIM - R2 - Gut-liver homeostasis
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
PREDICTION
medicine.medical_treatment
030230 surgery
STROKE VOLUME OPTIMIZATION
law.invention
RESPONSIVENESS
Intraoperative Period
0302 clinical medicine
Randomized controlled trial
Fluid therapy
intestinal fatty acid-binding protein
030202 anesthesiology
law
Postoperative Period
Intestinal Mucosa
Gastric tonometry
Gastroenterology
Stroke volume
Colorectal surgery
Intestines
Treatment Outcome
COLECTOMY
Female
Colorectal Neoplasms
ORGAN FAILURE
Perfusion
Goals
medicine.medical_specialty
Manometry
Urology
Malignancy
Fatty Acid-Binding Proteins
perfusion
CLINICAL-TRIAL
03 medical and health sciences
medicine
MANAGEMENT
Humans
CARDIAC-OUTPUT
Ultrasonography
Interventional
Aged
business.industry
CRITICALLY-ILL
Stroke Volume
Ultrasonography
Doppler
Length of Stay
medicine.disease
Surgery
Gastrointestinal Tract
BOWEL SURGERY
colorectal surgery
business
Fluid replacement
Zdroj: Colorectal Disease, 19(12), 1081-1091. Wiley
ISSN: 1463-1318
1462-8910
DOI: 10.1111/codi.13923
Popis: Aim Individualized, goal-directed fluid therapy (GDFT), based on Doppler measurements of stroke volume, has been proposed as a treatment strategy in terms of reducing complications, mortality and length of hospital stay in major bowel surgery. We studied the effect of Doppler-guided GDFT on intestinal damage as compared with standard postoperative fluid replacement.Method Patients undergoing elective colorectal resection for malignancy were randomized either to standard intra- and postoperative fluid therapy or to standard fluid therapy with additional Doppler-guided GDFT. The primary outcome was intestinal epithelial cell damage measured by plasma levels of intestinal fatty acid-binding protein (I-FABP). Global gastrointestinal perfusion was measured by gastric tonometry, expressed as regional (gastric) minus arterial CO2-gap (Pr-aCO2-gap).Results I-FABP levels were not significantly different between the intervention group and the control group (respectively, 440.8 (251.6) pg/ml and 522.4 (759.9) pg/ml, P=0.67). Mean areas under the curve (AUCs) of intra-operative Pr-aCO2-gaps were significantly lower in the intervention group than in the control group (P=0.01), indicating better global gastrointestinal perfusion in the intervention group. Moreover, the mean intra-operative Pr-aCO2-gap peak in the intervention group was 0.5 (1.0) kPa, which was significantly lower than the mean peak in the control group, of 1.4 (1.4) kPa (P=0.03).Conclusion Doppler-guided GDFT during and in the first hours after elective colorectal surgery for malignancy increases global gastrointestinal perfusion, as measured by Pr-aCO2-gap.
Databáze: OpenAIRE
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