Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
Scoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemo...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-08-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/8/1371 |
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| author | Jakub Miegoń Sławomir Zacha Karolina Skonieczna-Żydecka Agata Wiczk-Bratkowska Agata Andrzejewska Konrad Jarosz Monika Deptuła-Jarosz Jowita Biernawska |
| author_facet | Jakub Miegoń Sławomir Zacha Karolina Skonieczna-Żydecka Agata Wiczk-Bratkowska Agata Andrzejewska Konrad Jarosz Monika Deptuła-Jarosz Jowita Biernawska |
| author_sort | Jakub Miegoń |
| collection | DOAJ |
| description | Scoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemodynamic monitoring and goal-directed therapy in relation to patient outcomes following posterior fusion surgery for adolescent idiopathic scoliosis (AIS). The control group (<i>n </i>= 35, mean age: 15 years) received standard blood pressure management during the surgical procedure, whereas the intervention group (<i>n </i>= 35, mean age: 14 years) underwent minimally invasive haemodynamic monitoring. Arterial pulse contour analysis (APCO) devices were employed, along with goal-directed therapy protocol centered on achieving target mean arterial pressure and stroke volume. This was facilitated through the application of crystalloid boluses, ephedrine, and noradrenaline. The intervention group was subjected to a comprehensive protocol following Enhanced Recovery After Surgery (ERAS) principles. Remarkably, the intervention group exhibited notable advantages (<i>p</i> < 0.05), including reduced hospital stay durations (median 7 days vs. 10), shorter episodes of hypotension (mean arterial pressure < 60 mmHg—median 8 vs. 40 min), lesser declines in postoperative haemoglobin levels (−2.36 g/dl vs. −3.83 g/dl), and quicker extubation times. These compelling findings strongly imply that the integration of targeted interventions during the intraoperative care of AIS patients undergoing posterior fusion enhance a set of treatment outcomes. |
| first_indexed | 2024-03-11T00:02:50Z |
| format | Article |
| id | doaj.art-ddd063a0ce174236b60794a1a305ee79 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T00:02:50Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-ddd063a0ce174236b60794a1a305ee792023-11-19T00:40:33ZengMDPI AGChildren2227-90672023-08-01108137110.3390/children10081371Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving OutcomesJakub Miegoń0Sławomir Zacha1Karolina Skonieczna-Żydecka2Agata Wiczk-Bratkowska3Agata Andrzejewska4Konrad Jarosz5Monika Deptuła-Jarosz6Jowita Biernawska7Department of Anaesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, 71-252 Szczecin, PolandDepartment of Paediatric Orthopaedics and Oncology of the Musculoskeletal System, Pomeranian Medical University in Szczecin, 71-252 Szczecin, PolandDepartment of Biochemical Science, Pomeranian Medical University in Szczecin, 71-460 Szczecin, PolandDepartment of Anaesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, 71-252 Szczecin, PolandDepartment of Anaesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, 71-252 Szczecin, PolandDepartment of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, PolandDepartment of Neurosurgery and Paediatric Neurosurgery, Pomeranian Medical University in Szczecin, 71-252 Szczecin, PolandDepartment of Anaesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, 71-252 Szczecin, PolandScoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemodynamic monitoring and goal-directed therapy in relation to patient outcomes following posterior fusion surgery for adolescent idiopathic scoliosis (AIS). The control group (<i>n </i>= 35, mean age: 15 years) received standard blood pressure management during the surgical procedure, whereas the intervention group (<i>n </i>= 35, mean age: 14 years) underwent minimally invasive haemodynamic monitoring. Arterial pulse contour analysis (APCO) devices were employed, along with goal-directed therapy protocol centered on achieving target mean arterial pressure and stroke volume. This was facilitated through the application of crystalloid boluses, ephedrine, and noradrenaline. The intervention group was subjected to a comprehensive protocol following Enhanced Recovery After Surgery (ERAS) principles. Remarkably, the intervention group exhibited notable advantages (<i>p</i> < 0.05), including reduced hospital stay durations (median 7 days vs. 10), shorter episodes of hypotension (mean arterial pressure < 60 mmHg—median 8 vs. 40 min), lesser declines in postoperative haemoglobin levels (−2.36 g/dl vs. −3.83 g/dl), and quicker extubation times. These compelling findings strongly imply that the integration of targeted interventions during the intraoperative care of AIS patients undergoing posterior fusion enhance a set of treatment outcomes.https://www.mdpi.com/2227-9067/10/8/1371adolescent idiopathic scoliosishaemodynamic monitoringhypotensionlength of stayERAS (enhanced recovery after surgery) |
| spellingShingle | Jakub Miegoń Sławomir Zacha Karolina Skonieczna-Żydecka Agata Wiczk-Bratkowska Agata Andrzejewska Konrad Jarosz Monika Deptuła-Jarosz Jowita Biernawska Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes Children adolescent idiopathic scoliosis haemodynamic monitoring hypotension length of stay ERAS (enhanced recovery after surgery) |
| title | Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes |
| title_full | Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes |
| title_fullStr | Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes |
| title_full_unstemmed | Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes |
| title_short | Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes |
| title_sort | optimising intraoperative fluid management in patients treated with adolescent idiopathic scoliosis a novel strategy for improving outcomes |
| topic | adolescent idiopathic scoliosis haemodynamic monitoring hypotension length of stay ERAS (enhanced recovery after surgery) |
| url | https://www.mdpi.com/2227-9067/10/8/1371 |
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