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Randomized Controlled Trial
. 2015 Oct 15:15:148.
doi: 10.1186/s12871-015-0131-8.

Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement

Jan Benes  1 , Lenka Haidingerova  2 , Jiri Pouska  2 , Jan Stepanik  2 , Alena Stenglova  2 , Jan Zatloukal  2 , Richard Pradl  2 , Ivan Chytra  2 , Eduard Kasal  2
Affiliations
Randomized Controlled Trial

Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement

Jan Benes et al. BMC Anesthesiol. .

Abstract

Background: The use of goal directed fluid protocols in intermediate risk patients undergoing hip or knee replacement was studied in few trials using invasive monitoring. For this reason we have implemented two different fluid management protocols, both based on a novel totally non-invasive arterial pressure monitoring device and compared them to the standard (no-protocol) treatment applied before the transition in our academic institution.

Methods: Three treatment groups were compared in this prospective study: the observational (CONTROL, N = 40) group before adoption of fluid protocols and two randomized groups after the transition to protocol fluid management with the use of the continuous non-invasive blood pressure monitoring (CNAP®) device. In the PRESSURE group (N = 40) standard variables were used for restrictive fluid therapy. Goal directed fluid therapy using pulse pressure variation was used in the GDFT arm (N = 40). The influence on the rate of postoperative complications, on the hospital length of stay and other parameters was assessed.

Results: Both protocols were associated with decreased fluid administration and maintained hemodynamic stability. Reduced rate of postoperative infection and organ complications (22 (55 %) vs. 33 (83 %) patients; p = 0.016; relative risk 0.67 (0.49-0.91)) was observed in the GDFT group compared to CONTROL. Lower number of patients receiving transfusion (4 (10 %) in GDFT vs. 17 (43 %) in CONTROL; p = 0.005) might contribute to this observation. No significant differences were observed in other end-points.

Conclusion: In our study, the use of the fluid protocol based on pulse pressure variation assessed using continuous non-invasive arterial pressure measurement seems to be associated with a reduction in postoperative complications and transfusion needs as compared to standard no-protocol treatment.

Trial registration: ACTRN12612001014842.

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Figures

Fig. 1
Fig. 1
The protocols of fluid management in the second-stage groups (PRESSURE – panel a; GDFT – panel b). Legend: HR – hear rate; MAP – mean arterial pressure; PPV – pulse pressure variation; IPPV – Volume controlled ventilation; Vt – Tidal volume; PEEP – Positive End-Expiratory Pressure; RR – respiratory rate
Fig. 2
Fig. 2
The flow chart of patients through the trial. Legend: ITT – intention-to-treat analysis
Fig. 3
Fig. 3
Haemoglobin levels in perioperative period. Legend: # - significant difference PRESSURE vs. GDFT groups; $ - significant difference PRESSURE vs. CONTROL groups; * - significant difference GDFT vs. CONTROL groups (all ANOVA with Student-Neuman-Keul’s post hoc analysis); the drop against baseline measurement was significant in all groups and time-points
See this image and copyright information in PMC

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