Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients

Article type: Research Article

Authors: Kratz, Thomas^{a; b; *} | Simon, Christina^a | Fendrich, Volker^c | Schneider, Ralph^d | Wulf, Hinnerk^a | Kratz, Caroline^{a; b} | Efe, Turgay^e | Schüttler, Karl F.^e | Zoremba, Martin^{a; f}

Affiliations: [a] Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany | [b] Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France | [c] Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Marburg, Germany | [d] Center for Hereditary Tumors at the Surgical Center, HELIOS Klinikum Wuppertal, University Witten/Herdecke, Wuppertal, Germany | [e] Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany | [f] Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Kreisklinikum, Siegen, Germany

Correspondence: [*] Corresponding author: Thomas Kratz, Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Baldinger Strasse, D-35033 Marburg, Germany. Tel.: +33 645477425; Fax: +33 380583698; E-mail:[email protected]

Abstract: BACKGROUND: Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). OBJECTIVE: We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes. METHODS: All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors. RESULTS: Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group. CONCLUSIONS: Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery.

Keywords: Goal directed therapy, major abdominal surgery, pancreatic surgery, pluse-contour-automated-analysis, fluid therapy

DOI: 10.3233/THC-161237

Journal: Technology and Health Care, vol. 24, no. 6, pp. 899-907, 2016