Rinehart J, Le Manach Y, Douiri H, Lee C, Lilot M, Le K, Canales C, Cannesson M
Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA.
Department of anesthesiology and critical Care medicine, CHU Pitié-Salpêtrière, Paris, France; Departments of anesthesia and clinical epidemiology and biostatistics, faculty of health sciences, McMaster university and population health research institute, perioperative medicine and surgical research Unit, Hamilton, ON, Canada.
Ann Fr Anesth Reanim. 2014 Mar;33(3):e35-41. doi: 10.1016/j.annfar.2013.11.016. Epub 2013 Dec 27.
Intraoperative haemodynamic optimization based on fluid management and stroke volume optimization (Goal Directed Fluid Therapy [GDFT]) can improve patients' postoperative outcome. We have described a closed-loop fluid management system based on stroke volume variation and stroke volume monitoring. The goal of this system is to apply GDFT protocols automatically. After conducting simulation, engineering, and animal studies the present report describes the first use of this system in the clinical setting.
Prospective pilot study.
Patients undergoing major surgery.
Twelve patients at two institutions had intraoperative GDFT delivered by closed-loop controller under the direction of an anaesthesiologist. Compliance with GDFT management was defined as acceptable when a patient spent more than 85% of the surgery time in a preload independent state (defined as stroke volume variation<13%), or when average cardiac index during the case was superior or equal to 2.5l/min/m(2).
Closed-loop GDFT was completed in 12 patients. Median surgery time was 447 [309-483] min and blood loss was 200 [100-1000] ml. Average cardiac index was 3.2±0.8l/min/m(2) and on average patients spent 91% (76 to 100%) of the surgery time in a preload independent state. Twelve of 12 patients met the criteria for compliance with intraoperative GDFT management.
Intraoperative GDFT delivered by closed-loop system under anaesthesiologist guidance allowed to obtain targeted objectives in 91% of surgery time. This approach may provide a way to ensure consistent high-quality delivery of fluid administration and compliance with perioperative goal directed therapy.
基于液体管理和每搏量优化的术中血流动力学优化（目标导向液体治疗[GDFT]）可改善患者术后结局。我们描述了一种基于每搏量变异和每搏量监测的闭环液体管理系统。该系统的目标是自动应用GDFT方案。在进行模拟、工程和动物研究后，本报告描述了该系统在临床环境中的首次使用。
前瞻性试点研究。
接受大手术的患者。
两个机构的12名患者在麻醉医生的指导下，通过闭环控制器进行术中GDFT。当患者在预负荷独立状态（定义为每搏量变异<13%）下度过超过85%的手术时间，或病例期间平均心脏指数高于或等于2.5l/min/m²时，GDFT管理的依从性被定义为可接受。
12名患者完成了闭环GDFT。中位手术时间为447[309 - 483]分钟，失血量为200[100 - 1000]毫升。平均心脏指数为3.2±0.8l/min/m²，患者平均在预负荷独立状态下度过91%（76%至100%）的手术时间。12名患者中有12名符合术中GDFT管理的依从性标准。
在麻醉医生指导下，通过闭环系统进行术中GDFT可在91%的手术时间内实现目标。这种方法可能提供一种确保液体输注质量一致且符合围手术期目标导向治疗的途径。
