Intraoperative haemodynamic optimisation therapy with venoarterial carbon dioxide difference and pulse pressure
Lívia Prado1, Francisco Lobo1, Neymar de Oliveira2
1Department of Anaesthesiology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto - SP, Brazil.
Anaesthesiology Intensive Therapy
|November 9, 2020
Summary
An algorithm using CO2 gap and PPV targets in goal-directed haemodynamic therapy significantly reduced complications and mortality in high-risk gastrointestinal surgery patients.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Surgical Oncology
Background:
- Intraoperative goal-directed haemodynamic therapy (GDT) is recommended for high-risk patients undergoing major gastrointestinal surgery.
- Optimizing hemodynamic targets during surgery may reduce postoperative complications.
Purpose of the Study:
- To evaluate an algorithm using venoarterial carbon dioxide difference (CO2 gap) and pulse pressure variation (PPV) as targets for GDT.
- To determine if this algorithm decreases major complications in high-risk patients undergoing major gastrointestinal surgery.
Main Methods:
- A before-and-after study (n=204) included patients undergoing elective open major gastrointestinal surgery.
- The intervention group (IG) received GDT guided by an algorithm targeting MAP > 65 mm Hg, SpO2 > 95%, CO2 gap < 6 mm Hg, and PPV < 13%.
- The control group (CG) received standard care before algorithm implementation.
Main Results:
- The IG had significantly lower rates of moderate and severe postoperative complications (11% vs. 23%, P=0.025).
- 90-day mortality was lower in the IG (9.8% vs. 22.5%, P=0.014).
- 180-day mortality was also lower in the IG (12.6% vs. 25.5%, P=0.020).
Conclusions:
- An algorithm utilizing CO2 gap and PPV targets is feasible and effective.
- This approach reduces moderate to severe complications in high-risk surgical patients.
- Optimized GDT can improve outcomes in major gastrointestinal surgery.
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