Davide Corbella1,2, Patrick Jason Toppin1,2, Anand Ghanekar3, Nour Ayach1, Jeffery Schiff4, Adrian Van Rensburg1,2, Stuart A McCluskey5,6. 1. Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Eaton North 3-405, Toronto, ON, M5G 2C4, Canada. 2. Department of Anesthesia, University of Toronto, Toronto, ON, Canada. 3. Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. 4. Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. 5. Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Eaton North 3-405, Toronto, ON, M5G 2C4, Canada. Stuart.mccluskey@uhn.ca. 6. Department of Anesthesia, University of Toronto, Toronto, ON, Canada. Stuart.mccluskey@uhn.ca.
Abstract
PURPOSE: Intravenous fluid management for deceased donor kidney transplantation is an important, modifiable risk factor for delayed graft function (DGF). The primary objective of this study was to determine if goal-directed fluid therapy using esophageal Doppler monitoring (EDM) to optimize stroke volume (SV) would alter the amount of fluid given. METHODS: This randomized, proof-of-concept trial enrolled 50 deceased donor renal transplant recipients. Data collected included patient characteristics, fluid administration, hemodynamics, and complications. The EDM was used to optimize SV in the EDM group. In the control group, fluid management followed the current standard of practice. The groups were compared for the primary outcome of total intraoperative fluid administered. RESULTS: There was no difference in the mean (standard deviation) volume of intraoperative fluid administered to the 24 control and 26 EDM patients [2,307 (750) mL vs 2,675 (842) mL, respectively; mean difference, 368 mL; 95% confidence interval (CI), - 87 to + 823; P = 0.11]. The incidence of complications in the control and EDM groups was similar (15/24 vs 17/26, respectively; P = 0.99), as was the incidence of delayed graft failure (8/24 vs 11/26, respectively; P = 0.36). CONCLUSIONS: Goal-directed fluid therapy did not alter the volume of fluid administered or the incidence of complications. This proof-of-concept trial provides needed data for conducting a larger trial to determine the influence of fluid therapy on the incidence in DGF in deceased donor kidney transplantation. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02512731). Registered 31 July 2015.
RCT Entities:
PURPOSE: Intravenous fluid management for deceased donor kidney transplantation is an important, modifiable risk factor for delayed graft function (DGF). The primary objective of this study was to determine if goal-directed fluid therapy using esophageal Doppler monitoring (EDM) to optimize stroke volume (SV) would alter the amount of fluid given. METHODS: This randomized, proof-of-concept trial enrolled 50 deceased donor renal transplant recipients. Data collected included patient characteristics, fluid administration, hemodynamics, and complications. The EDM was used to optimize SV in the EDM group. In the control group, fluid management followed the current standard of practice. The groups were compared for the primary outcome of total intraoperative fluid administered. RESULTS: There was no difference in the mean (standard deviation) volume of intraoperative fluid administered to the 24 control and 26 EDM patients [2,307 (750) mL vs 2,675 (842) mL, respectively; mean difference, 368 mL; 95% confidence interval (CI), - 87 to + 823; P = 0.11]. The incidence of complications in the control and EDM groups was similar (15/24 vs 17/26, respectively; P = 0.99), as was the incidence of delayed graft failure (8/24 vs 11/26, respectively; P = 0.36). CONCLUSIONS: Goal-directed fluid therapy did not alter the volume of fluid administered or the incidence of complications. This proof-of-concept trial provides needed data for conducting a larger trial to determine the influence of fluid therapy on the incidence in DGF in deceased donor kidney transplantation. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02512731). Registered 31 July 2015.
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