Optimising stroke volume and oxygen delivery in abdominal aortic surgery: a randomised controlled trial

• Published in: Acta anaesthesiologica Scandinavica Vol. 57; no. 2; pp. 178 - 188
• Main Authors: BISGAARD, J., GILSAA, T., RØNHOLM, E., TOFT, P.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.02.2013; Blackwell; Wiley Subscription Services, Inc
• Subjects: Abdomen; Adrenergic beta-Agonists - therapeutic use; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta, Abdominal - surgery; Biological and medical sciences; Blood Gas Analysis; Dobutamine - therapeutic use; Endpoint Determination; Female; Hemodynamics - physiology; Humans; Hydroxyethyl Starch Derivatives - therapeutic use; Intensive care; Intensive Care Units; Length of Stay; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Oxygen; Oxygen - administration & dosage; Oxygen - therapeutic use; Perioperative Care; Plasma Substitutes - therapeutic use; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Postoperative period; Precision Medicine; Prospective Studies; Stroke; Stroke Volume - physiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - methods; Vascular disease; Nervous system diseases; Stroke; Oxygen; Surgery; Central nervous system disease; Cardiovascular disease; Anesthesia; Aorta; Cerebrovascular disease; Cerebral disorder
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2012.02756.x

Background Post‐operative complications after open elective abdominal aortic surgery are common, and individualised goal‐directed therapy may improve outcome in high‐risk surgery. We hypothesised that individualised goal‐directed therapy, targeting stroke volume and oxygen delivery, can reduce complications and minimise length of stay in intensive care unit and hospital following open elective abdominal aortic surgery. Methods Seventy patients scheduled for open elective abdominal aortic surgery were randomised to individualised goal‐directed therapy or conventional therapy. In the intervention group, stroke volume was optimised by 250 ml colloid boluses intraoperatively and for the first 6 h post‐operatively. The optimisation aimed at an oxygen delivery of 600 ml/min/m2 in the post‐operative period. Haemodynamic data were collected at pre‐defined time points, including baseline, intraoperatively and post‐operatively. Patients were followed up for 30 days. Results Stroke volume index and oxygen delivery index were both higher in the post‐operative period in the intervention group. In this group, 27 of 32 achieved the post‐operative oxygen delivery index target vs. 18 of 32 in the control group (P = 0.01). However, the number of complications per patient or length of stay in the intensive care unit or hospital did not differ between the groups. Conclusion Perioperative individualised goal‐directed therapy targeting stroke volume and oxygen delivery did not affect post‐operative complications, intensive care unit or hospital length of stay in open elective abdominal aortic surgery.