The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study
Abstract Background To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods Patients, more than 60 years old, u...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Perioperative Medicine |
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| Online Access: | https://doi.org/10.1186/s13741-023-00327-x |
| _version_ | 1797778741654454272 |
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| author | Hongmei Ma Xin Li Zhe Wang Qiao Qiao Yanfeng Gao Hui Yuan Bin Guan Zheng Guan |
| author_facet | Hongmei Ma Xin Li Zhe Wang Qiao Qiao Yanfeng Gao Hui Yuan Bin Guan Zheng Guan |
| author_sort | Hongmei Ma |
| collection | DOAJ |
| description | Abstract Background To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods Patients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared. Results Two-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048). Conclusions Under ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group. Trial registration Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020. |
| first_indexed | 2024-03-12T23:21:54Z |
| format | Article |
| id | doaj.art-054368be3c0644999081b2b7ef38098c |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-03-12T23:21:54Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-054368be3c0644999081b2b7ef38098c2023-07-16T11:23:18ZengBMCPerioperative Medicine2047-05252023-07-0112111110.1186/s13741-023-00327-xThe effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled studyHongmei Ma0Xin Li1Zhe Wang2Qiao Qiao3Yanfeng Gao4Hui Yuan5Bin Guan6Zheng Guan7Department of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong UniversityAbstract Background To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods Patients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared. Results Two-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048). Conclusions Under ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group. Trial registration Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.https://doi.org/10.1186/s13741-023-00327-xGoal-directed fluid therapyEnhanced recovery after surgeryAcute kidney injuryPulmonary resection |
| spellingShingle | Hongmei Ma Xin Li Zhe Wang Qiao Qiao Yanfeng Gao Hui Yuan Bin Guan Zheng Guan The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study Perioperative Medicine Goal-directed fluid therapy Enhanced recovery after surgery Acute kidney injury Pulmonary resection |
| title | The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study |
| title_full | The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study |
| title_fullStr | The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study |
| title_full_unstemmed | The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study |
| title_short | The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study |
| title_sort | effect of intraoperative goal directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection a prospective randomized controlled study |
| topic | Goal-directed fluid therapy Enhanced recovery after surgery Acute kidney injury Pulmonary resection |
| url | https://doi.org/10.1186/s13741-023-00327-x |
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