Morten Bundgaard-Nielsen1, Øivind Jans, Rasmus G Müller, André Korshin, Birgitte Ruhnau, Peter Bie, Niels H Secher, Henrik Kehlet. 1. * Research Fellow, ‡ Research Assistant, Section of Surgical Pathophysiology, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, and Department of Anesthesiology, The Abdominal Center, Copenhagen University Hospital, Rigshospitalet. † Research Fellow, †† Professor, Section of Surgical Pathophysiology, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet. § Staff Anesthesiologist, ‖ Head of Department, ** Professor, Department of Anesthesiology, The Abdominal Center, Copenhagen University Hospital, Rigshospitalet. # Professor, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
Abstract
BACKGROUND: Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume-guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial. METHODS:Forty-two patients scheduled for open radical prostatectomy were randomized into standard fluid therapy (control group) or GDT groups. Both groups received a fixed-volume crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid, and in addition, the GDT group received colloid to obtain a maximal stroke volume (esophageal Doppler). The primary outcome was the prevalence of OI assessed with a standardized mobilization protocol before and 6 h after surgery. Hemodynamic and hormonal orthostatic responses were evaluated. RESULTS: Twelve (57%) versus 15 (71%) patients in the control and GDT groups (P = 0.33), respectively, demonstrated OI after surgery, group difference 14% (CI, -18 to 45%). Patients in the GDT group received more colloid during surgery (1,758 vs. 1,057 ml; P = 0.001) and reached a higher stroke volume (102 vs. 89 ml; P = 0.04). OI patients had an increased length of hospital stay (3 vs. 2 days; P = 0.02) and impaired hemodynamic and norepinephrine responses on mobilization. CONCLUSION:GDT did not reduce the prevalence of OI, and patients with OI demonstrated impaired cardiovascular and hormonal responses to mobilization.
RCT Entities:
BACKGROUND: Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume-guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial. METHODS: Forty-two patients scheduled for open radical prostatectomy were randomized into standard fluid therapy (control group) or GDT groups. Both groups received a fixed-volume crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid, and in addition, the GDT group received colloid to obtain a maximal stroke volume (esophageal Doppler). The primary outcome was the prevalence of OI assessed with a standardized mobilization protocol before and 6 h after surgery. Hemodynamic and hormonal orthostatic responses were evaluated. RESULTS: Twelve (57%) versus 15 (71%) patients in the control and GDT groups (P = 0.33), respectively, demonstrated OI after surgery, group difference 14% (CI, -18 to 45%). Patients in the GDT group received more colloid during surgery (1,758 vs. 1,057 ml; P = 0.001) and reached a higher stroke volume (102 vs. 89 ml; P = 0.04). OI patients had an increased length of hospital stay (3 vs. 2 days; P = 0.02) and impaired hemodynamic and norepinephrine responses on mobilization. CONCLUSION:GDT did not reduce the prevalence of OI, and patients with OI demonstrated impaired cardiovascular and hormonal responses to mobilization.
Authors: A Feldheiser; O Aziz; G Baldini; B P B W Cox; K C H Fearon; L S Feldman; T J Gan; R H Kennedy; O Ljungqvist; D N Lobo; T Miller; F F Radtke; T Ruiz Garces; T Schricker; M J Scott; J K Thacker; L M Ytrebø; F Carli Journal: Acta Anaesthesiol Scand Date: 2015-10-30 Impact factor: 2.105
Authors: Marie K Jessen; Mikael F Vallentin; Mathias J Holmberg; Maria Bolther; Frederik B Hansen; Johanne M Holst; Andreas Magnussen; Niklas S Hansen; Cecilie M Johannsen; Johannes Enevoldsen; Thomas H Jensen; Lara L Roessler; Peter C Lind; Maibritt P Klitholm; Mark A Eggertsen; Philip Caap; Caroline Boye; Karol M Dabrowski; Lasse Vormfenne; Maria Høybye; Jeppe Henriksen; Carl M Karlsson; Ida R Balleby; Marie S Rasmussen; Kim Pælestik; Asger Granfeldt; Lars W Andersen Journal: Br J Anaesth Date: 2021-12-13 Impact factor: 11.719
Authors: Anna Wrzosek; Joanna Jakowicka-Wordliczek; Renata Zajaczkowska; Wojciech T Serednicki; Milosz Jankowski; Malgorzata M Bala; Mateusz J Swierz; Maciej Polak; Jerzy Wordliczek Journal: Cochrane Database Syst Rev Date: 2019-12-12