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Haemodynamic management during hyperthermic intraperitoneal chemotherapy: A systematic review
Lucillia Bezu1, Mégane Raineau2, Myriam Deloménie3
1Service d'anesthésie, hôpitaux universitaires Paris Ouest, hôpital européen Georges Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Goal-directed fluid administration during hyperthermic intraperitoneal chemotherapy (HIPEC) surgery may reduce complications and mortality. Advanced hemodynamic monitoring is key for better patient outcomes in HIPEC procedures.
Area of Science:
- Oncology
- Surgical Oncology
- Anesthesiology
Background:
- Hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure for peritoneal carcinomatosis.
- It involves cytoreduction surgery and chemotherapy irrigation, significantly impacting hemodynamics and fluid balance.
- Current intraoperative management guidelines for HIPEC are lacking.
Purpose of the Study:
- To review existing data on hemodynamic monitoring and management in HIPEC patients.
- To inform the development of standardized anesthetic protocols for HIPEC procedures.
Main Methods:
- A systematic literature search was conducted across MEDLINE, EMBASE, and the Cochrane Library.
- Original articles and case reports were included; letters and reviews were excluded.
- Data extraction focused on hemodynamic management, patient morbidity, and mortality.
Main Results:
- Hemodynamic management during HIPEC is highly variable and protocol-dependent.
- Goal-directed fluid administration (GDFA) using advanced monitoring showed reduced complications, shorter hospital stays, and lower mortality compared to standard fluid administration.
- Renal protection strategies did not significantly reduce the incidence of acute kidney injury (AKI).
Conclusions:
- Fluid administration guided by advanced hemodynamic monitoring appears to improve postoperative outcomes in HIPEC.
- Significant variability exists in current intraoperative hemodynamic management practices for HIPEC.
- Further prospective trials are essential to compare different fluid management and monitoring strategies in HIPEC.
