Κατεύθυνση Μονάδες Εντατικής Θεραπείας και Επείγουσα Νοσηλευτική
Library of the School of Health Sciences

2019-09-17

2019

Mavroeidi Dimitra

Μελεμενή Αικατερίνη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Παρασκευά Άντεια, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Καλεμικεράκης Ιωάννης Επίκουρος Καθηγητής, Τμήμα Νοσηλευτικής, Πανεπιστήμιο Δυτικής Αττικής

Η στοχευμένη χορήγηση υγρών σε επεμβάσεις κοιλίας. Κριτήριο ταχείας ανάρρωσης

Greek

Goal directed fluid therapy in abdomen surgeries. A criterion of enhanced recovery.

INTRODUCTION
Surgical procedures are associated with significant rates of postoperative complications and postoperative mortality. The risk of postoperative complications appears to increase depending on the type and duration of surgery, age as well as co-morbidity.
AIM
Aim of this research work was to investigate possible changes in lactate values, alveolar-arterial gradient and hemoglobin in arterial blood, at the end of the procedure, in adults scheduled for major abdominal surgery, as well as to investigate possible correlations of these changes with the intraoperative application of a targeted to the PPV-guided fluid therapy protocol .
MATERIAL-METHODS
This is a prospective study conducted at the SISMANOGLEIO, in adult patients who underwent an elective major abdominal surgery. In the control group, intraoperative fluids were administered based on classical principles. In the intervention group, fluids were administered with the target of maintaining a PPV < 8 value. The main objective was to measure the change of (LA) lactate value, the Alveolar-arterial gradient (A-a) O2 and hemoglobin (Hb) in three times, t0, t1 and t2.
RESULTS
After obtaining approval from the Institutional Review Board (IRB), 30 gave written informed consent to participate in the study. Fifteen patients (51.7%) received goal directed fluid therapy and 14 patients (48.3%) received classical administration. In the main results it appeared that LA increased in both groups of patients over time, but the increase was statistically significantly greater in patients who received classical therapy (P < 0,001). (A-a) O2 was increased in both patient groups over time, but the difference was statistically significantly greater in patients who received classical therapy (P < 0,001). We found no difference in the Hb values
CONCLUSIONS
The results of PPV guided goal directed fluid therapy, with the use of Android App Capstesia for haemodynamic monitoring, was statistically significantly correlated to reduced Lactate and Alveolar- Arterial gradient in the intervention group than the control group of adults undergoing elective major abdominal surgery. Monitoring of the change in lactate levels has a clinical benefit in the prevention of the occult tissue hypoperfusion. Goal directed fluid therapy intraoperatively could be related to criterion of enhanced surgical recovery. More studies are required to validate and expand these data to patients undergoing major surgery. The method and the apparatus may be useful to monitor the oxygenation of the tissues.

Health Sciences

Surgical recovery and outcomes, Major abdominal surgery, Goal directed fluid therapy, Lactate, Haemodynamic optimization

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Yes

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https://pergamos.lib.uoa.gr/uoa/dl/object/2880830