Jakob Mühlbacher1, Florian Luf2, Oliver Zotti3, Harald Herkner3, Edith Fleischmann4,5, Barbara Kabon3. 1. Department of Surgery, Division of General Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. 2. Department of Anaesthesiology and Intensive Care, Hanusch Hospital, Heinrich-Collin-Strasse 30, 1140, Vienna, Austria. 3. Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 4. Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. edith.fleischmann@meduniwien.ac.at. 5. Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University Vienna, Spitalgasse 23, A-1090, Vienna, Austria. edith.fleischmann@meduniwien.ac.at.
Abstract
BACKGROUND:Perioperative subcutaneous tissue oxygen tension (PsqO2) is substantially reduced in obese surgical patients. Goal-directed fluid therapy optimizes cardiac performance and thus tissue perfusion and oxygen delivery. We therefore tested the hypothesis that intra- and postoperative PsqO2 is significantly reduced in obese patients undergoing standard fluid management compared to goal-directed fluid administration. METHODS: We randomly assigned 60 obese patients (BMI ≥ 30 kg/m2) undergoinglaparoscopic bariatric surgery to receive either esophageal Doppler-guided goal-directed fluid management or conventional fluid treatment. Our primary outcome parameter was intra- and postoperative PsqO2 measured with a polarographic electrode in the subcutaneous tissue of the upper arm. A random effects linear regression model was used to analyze the effect of intervention. RESULTS:Overall, mean (± SD) PsqO2 was significantly higher in obese patients receiving goal-directed therapy compared to conventional fluid therapy (65.8 ± 28.0 mmHg vs. 53.7 ± 21.7, respectively; repeated measures design adjusted difference: 13.0 mmHg [95% CI 2.3 to 23.7; p = 0.017]). No effect was seen intraoperatively (69.6 ± 27.9 mmHg vs. 61.4 ± 28.8, difference: 9.7 mmHg [95% CI -3.8 to 23.2; p = 0.160]); however, goal-directed fluid management improved PsqO2 in the early postoperative phase (63.1 ± 27.9 mmHg vs. 48.4 ± 12.5, difference: 14.5 mmHg [95% CI 4.1 to 24.9; p = 0.006]). Intraoperative fluid requirements did not differ between the two groups. CONCLUSIONS:Goal-directed fluid therapy improved subcutaneous tissue oxygenation in obese patients. This effect was more pronounced in the early postoperative period. CLINICAL TRIAL NUMBER AND REGISTRY: The study was registered at ClinicalTrials.gov (NCT01052519).
RCT Entities:
BACKGROUND: Perioperative subcutaneous tissue oxygen tension (PsqO2) is substantially reduced in obese surgical patients. Goal-directed fluid therapy optimizes cardiac performance and thus tissue perfusion and oxygen delivery. We therefore tested the hypothesis that intra- and postoperative PsqO2 is significantly reduced in obesepatients undergoing standard fluid management compared to goal-directed fluid administration. METHODS: We randomly assigned 60 obesepatients (BMI ≥ 30 kg/m2) undergoing laparoscopic bariatric surgery to receive either esophageal Doppler-guided goal-directed fluid management or conventional fluid treatment. Our primary outcome parameter was intra- and postoperative PsqO2 measured with a polarographic electrode in the subcutaneous tissue of the upper arm. A random effects linear regression model was used to analyze the effect of intervention. RESULTS: Overall, mean (± SD) PsqO2 was significantly higher in obesepatients receiving goal-directed therapy compared to conventional fluid therapy (65.8 ± 28.0 mmHg vs. 53.7 ± 21.7, respectively; repeated measures design adjusted difference: 13.0 mmHg [95% CI 2.3 to 23.7; p = 0.017]). No effect was seen intraoperatively (69.6 ± 27.9 mmHg vs. 61.4 ± 28.8, difference: 9.7 mmHg [95% CI -3.8 to 23.2; p = 0.160]); however, goal-directed fluid management improved PsqO2 in the early postoperative phase (63.1 ± 27.9 mmHg vs. 48.4 ± 12.5, difference: 14.5 mmHg [95% CI 4.1 to 24.9; p = 0.006]). Intraoperative fluid requirements did not differ between the two groups. CONCLUSIONS: Goal-directed fluid therapy improved subcutaneous tissue oxygenation in obesepatients. This effect was more pronounced in the early postoperative period. CLINICAL TRIAL NUMBER AND REGISTRY: The study was registered at ClinicalTrials.gov (NCT01052519).
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