A Joosten1, T Huynh2, K Suehiro3, C Canales2, M Cannesson2, J Rinehart4. 1. Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA Department of Anesthesiology and Critical Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium. 2. Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA. 3. Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan. 4. Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA jrinehar@uci.edu.
Abstract
BACKGROUND: Goal directed fluid therapy (GDFT) has been shown to improve outcomes in moderate to high-risk surgery. However, most of the present GDFT protocols based on cardiac output optimization use invasive devices and the protocols may require significant practitioner attention and intervention to apply them accurately. The aim of this prospective pilot study was to evaluate the clinical feasibility of GDFT using a closed-loop fluid administration system with a non-invasive cardiac output monitoring device (Nexfin™, BMEYE, Amsterdam, Netherlands). METHODS: Patients scheduled for elective moderate risk surgery under general anaesthesia were enrolled. The primary anaesthesia team managing the case selected GDFT targets using the controller interface and all patients received a baseline 3 ml kg(-1) h(-1) crystalloid infusion. Colloid solutions were delivered by the closed-loop system for intravascular volume expansion using data from the Nexfin™ monitor. Compliance with GDFT management was defined as acceptable when a patient spent more than 85% of the surgery time in a preload independent state (defined as pulse pressure variation <13%) or when average cardiac index during surgery was >2.5 litre min(-1) m(-2). RESULTS: A total of 13 patients were included in the study group. All patients met the established criteria for delivery of GDFT for greater than 85% of case time. The median length of stay in the hospital was 5 [3-6] days. CONCLUSION: In this pilot study, GDFT management using the closed-loop fluid administration system with a non-invasive CO monitoring device was feasible and maintained a high rate of protocol compliance. CLINICAL TRIAL REGISTRATION: NCT02020863.
BACKGROUND: Goal directed fluid therapy (GDFT) has been shown to improve outcomes in moderate to high-risk surgery. However, most of the present GDFT protocols based on cardiac output optimization use invasive devices and the protocols may require significant practitioner attention and intervention to apply them accurately. The aim of this prospective pilot study was to evaluate the clinical feasibility of GDFT using a closed-loop fluid administration system with a non-invasive cardiac output monitoring device (Nexfin™, BMEYE, Amsterdam, Netherlands). METHODS:Patients scheduled for elective moderate risk surgery under general anaesthesia were enrolled. The primary anaesthesia team managing the case selected GDFT targets using the controller interface and all patients received a baseline 3 ml kg(-1) h(-1) crystalloid infusion. Colloid solutions were delivered by the closed-loop system for intravascular volume expansion using data from the Nexfin™ monitor. Compliance with GDFT management was defined as acceptable when a patient spent more than 85% of the surgery time in a preload independent state (defined as pulse pressure variation <13%) or when average cardiac index during surgery was >2.5 litre min(-1) m(-2). RESULTS: A total of 13 patients were included in the study group. All patients met the established criteria for delivery of GDFT for greater than 85% of case time. The median length of stay in the hospital was 5 [3-6] days. CONCLUSION: In this pilot study, GDFT management using the closed-loop fluid administration system with a non-invasive CO monitoring device was feasible and maintained a high rate of protocol compliance. CLINICAL TRIAL REGISTRATION: NCT02020863.
Authors: Sean Coeckelenbergh; Cedrick Zaouter; Brenton Alexander; Maxime Cannesson; Joseph Rinehart; Jacques Duranteau; Philippe Van der Linden; Alexandre Joosten Journal: J Anesth Date: 2019-09-25 Impact factor: 2.078
Authors: Alexandre Joosten; Joseph Rinehart; Aurélie Bardaji; Philippe Van der Linden; Vincent Jame; Luc Van Obbergh; Brenton Alexander; Maxime Cannesson; Susana Vacas; Ngai Liu; Hichem Slama; Luc Barvais Journal: Anesthesiology Date: 2020-02 Impact factor: 7.892
Authors: Alexandre Joosten; Joseph Rinehart; Philippe Van der Linden; Brenton Alexander; Christophe Penna; Jacques De Montblanc; Maxime Cannesson; Jean-Louis Vincent; Eric Vicaut; Jacques Duranteau Journal: Anesthesiology Date: 2021-08-01 Impact factor: 8.986
Authors: Alexandre Joosten; Sean Coeckelenbergh; Brenton Alexander; Amélie Delaporte; Maxime Cannesson; Jacques Duranteau; Bernd Saugel; Jean-Louis Vincent; Philippe Van der Linden Journal: BMC Anesthesiol Date: 2020-08-20 Impact factor: 2.217