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. 2023 Jul 5;12(1):32.
doi: 10.1186/s13741-023-00321-3.

Effects of goal-directed fluid management guided by a non-invasive device on the incidence of postoperative complications in neurosurgery: a pilot and feasibility randomized controlled trial

Ondrej Hrdy  1   2 , Milos Duba  3   4 , Andrea Dolezelova  1   2 , Ivana Roskova  5   6 , Martin Hlavaty  1   2 , Rudolf Traj  1   2 , Vit Bönisch  1   2 , Martin Smrcka  5   6 , Roman Gal  1   2
Affiliations

Effects of goal-directed fluid management guided by a non-invasive device on the incidence of postoperative complications in neurosurgery: a pilot and feasibility randomized controlled trial

Ondrej Hrdy et al. Perioper Med (Lond). .

Abstract

Background: The positive effects of goal-directed hemodynamic therapy (GDHT) on patient-orientated outcomes have been demonstrated in various clinical scenarios; however, the effects of fluid management in neurosurgery remain unclear. Therefore, this study was aimed at assessing the safety and feasibility of GDHT using non-invasive hemodynamic monitoring in elective neurosurgery. The incidence of postoperative complications was compared between GDHT and control groups.

Methods: We conducted a single-center randomized pilot study with an enrollment target of 34 adult patients scheduled for elective neurosurgery. We randomly assigned the patients equally into control and GDHT groups. The control group received standard therapy during surgery and postoperatively, whereas the GDHT group received therapy guided by an algorithm based on non-invasive hemodynamic monitoring. In the GDHT group, we aimed to achieve and sustain an optimal cardiac index by using non-invasive hemodynamic monitoring and bolus administration of colloids and vasoactive drugs. The number of patients with adverse events, feasibility criteria, perioperative parameters, and incidence of postoperative complications was compared between groups.

Results: We successfully achieved all feasibility criteria. The GDHT protocol was safe, because no patients in either group had unsatisfactory brain tissue relaxation after surgery or brain edema requiring therapy during surgery or 24 h after surgery. Major complications occurred in two (11.8%) patients in the GDHT group and six (35.3%) patients in the control group (p = 0.105).

Conclusions: Our results suggested that a large randomized trial evaluating the effects of GDHT on the incidence of postoperative complications in elective neurosurgery should be safe and feasible. The rate of postoperative complications was comparable between groups.

Trial registration: Trial registration: ClininalTrials.gov, registration number: NCT04754295, date of registration: February 15, 2021.

Keywords: Complications; Goal-directed therapy; Hemodynamic monitoring; Neuro-anesthesia; Neurosurgery; Postoperative outcome.

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Conflict of interest statement

Dr. Hrdy reports grants and personal fees from MŠMT, during the conduct of the study. Dr. Duba reports grants and personal fees from MŠMT, during the conduct of the study.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram. CONSORT indicates Consolidated Standards of Reporting Trials
See this image and copyright information in PMC

References

    1. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS) Eur J Cardiothorac Surg. 2019;55:91–115. doi: 10.1093/ejcts/ezy301. - DOI - PubMed
    1. Bellamy MC. Wet, dry or something else? Br J Anaesth. 2006;97:755–757. doi: 10.1093/bja/ael290. - DOI - PubMed
    1. Benes J, Giglio M, Brienza N, Michard F. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care. 2014;18:584. doi: 10.1186/s13054-014-0584-z. - DOI - PMC - PubMed
    1. Benes J, Haidingerova L, Pouska J, et al. Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement. BMC Anesthesiol. 2015;15:148. doi: 10.1186/s12871-015-0131-8. - DOI - PMC - PubMed
    1. Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG, et al. Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial) Br J Anaesth. 2018;120:734–744. doi: 10.1016/j.bja.2017.12.018. - DOI - PubMed

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