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Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial

Hong Zheng1, Hai Guo, Jian-Rong Ye

  • 1Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Li yu Shan Street, Urumqi, 830054, Xinjiang, China, xjzhenghong@aliyun.com.

World Journal of Surgery
|September 20, 2013
PubMed

Insights

Goal-directed fluid therapy (GDT) improved recovery for elderly gastrointestinal surgery patients. GDT led to faster gastrointestinal function return and shorter hospital stays compared to traditional fluid management.

Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Gastroenterology
  • Cardiology

Background:

  • Elderly patients with coronary heart disease undergoing gastrointestinal surgery face risks.
  • Traditional fluid therapy may not optimize outcomes in this vulnerable population.
  • Goal-directed fluid therapy (GDT) is a potential alternative for perioperative fluid management.

Purpose of the Study:

  • To evaluate the advantages of GDT over traditional fluid therapy in elderly patients with coronary heart disease undergoing gastrointestinal surgery.
  • To determine if GDT reduces cardiac complications.
  • To assess if GDT shortens recovery and discharge times.

Main Methods:

  • A randomized controlled trial involving 60 elderly patients with coronary heart disease scheduled for gastrointestinal surgery.
  • Patients were divided into two groups: GDT (n=30) and control (n=30).
  • Fluid management in the GDT group was guided by hemodynamic indicators; data on fluid administration, blood loss, urine output, extubation time, ICU stay, hospital stay, and complications were recorded.

Main Results:

  • The GDT group received significantly less total fluid (2,910 ± 645 ml) compared to the control group (3,640 ± 771 ml).
  • No significant difference in adverse cardiac events was observed between the groups (p = 0.121).
  • The GDT group demonstrated significantly faster return of gastrointestinal function (p < 0.001), shorter ICU stays (median 32.5 vs. 47.5 hours; p < 0.001), and reduced hospital stays (median 18 vs. 22 days; p < 0.001).

Conclusions:

  • Goal-directed fluid therapy is associated with improved recovery outcomes in elderly patients undergoing gastrointestinal surgery.
  • GDT leads to shorter intensive care unit and hospital stays.
  • Faster return of gastrointestinal function is a key benefit of GDT in this patient cohort, with similar cardiac complication rates.
Abstract

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