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Assisted Fluid Management and Sublingual Microvascular Flow During High-Risk Abdominal Surgery: A Randomized

Sean Coeckelenbergh1,2, Marguerite Entzeroth1, Philippe Van der Linden3

  • 1From the Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, France.

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An assisted fluid management (AFM) system improved goal-directed fluid therapy (GDFT) outcomes, significantly increasing sublingual microvascular flow during high-risk surgery compared to standard GDFT. This novel tool enhances patient circulation and reduces vasopressor needs.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Surgical Oncology

Background:

  • Goal-directed fluid therapy (GDFT) implementation is often suboptimal due to high clinician workload.
  • An assisted fluid management (AFM) system is a decision support tool designed to improve GDFT protocol adherence.
  • AFM predicts fluid responsiveness and improves stroke volume (SV) and cardiac index (CI) during surgery.

Purpose of the Study:

  • To test if an AFM-guided GDFT strategy improves sublingual microvascular flow compared to standard GDFT.
  • To evaluate the impact of AFM on intraoperative hemodynamic parameters and postoperative lactate levels.

Main Methods:

  • A bicenter, randomized controlled trial involving high-risk abdominal surgery patients requiring arterial catheter and SV monitoring.
  • Patients received either standard GDFT (manual titration) or AFM-guided GDFT (software recommendations).
  • The primary outcome was intraoperative microvascular flow index (MFI); secondary outcomes included SV, CI, fluid volume, and lactate.

Main Results:

  • AFM-guided GDFT significantly increased intraoperative MFI compared to standard GDFT (median difference 0.30; P < .001).
  • Patients receiving AFM had higher cardiac index and SV, and lower end-of-surgery arterial lactate.
  • AFM patients received more fluid but required 3 times less norepinephrine (P < .001).

Conclusions:

  • AFM-guided GDFT enhances sublingual microvascular flow during high-risk surgery.
  • AFM shows potential for improving hemodynamic management and patient outcomes.
  • Further trials are needed to confirm clinical practice recommendations.