Joosten A, Huynh T, Suehiro K, Canales C, Cannesson M, Rinehart J
Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA Department of Anesthesiology and Critical Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.
Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA.
Br J Anaesth. 2015 Jun;114(6):886-92. doi: 10.1093/bja/aev002. Epub 2015 Feb 17.
Goal directed fluid therapy (GDFT) has been shown to improve outcomes in moderate to high-risk surgery. However, most of the present GDFT protocols based on cardiac output optimization use invasive devices and the protocols may require significant practitioner attention and intervention to apply them accurately. The aim of this prospective pilot study was to evaluate the clinical feasibility of GDFT using a closed-loop fluid administration system with a non-invasive cardiac output monitoring device (Nexfin™, BMEYE, Amsterdam, Netherlands).
Patients scheduled for elective moderate risk surgery under general anaesthesia were enrolled. The primary anaesthesia team managing the case selected GDFT targets using the controller interface and all patients received a baseline 3 ml kg(-1) h(-1) crystalloid infusion. Colloid solutions were delivered by the closed-loop system for intravascular volume expansion using data from the Nexfin™ monitor. 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 pulse pressure variation <13%) or when average cardiac index during surgery was >2.5 litre min(-1) m(-2).
A total of 13 patients were included in the study group. All patients met the established criteria for delivery of GDFT for greater than 85% of case time. The median length of stay in the hospital was 5 [3-6] days.
In this pilot study, GDFT management using the closed-loop fluid administration system with a non-invasive CO monitoring device was feasible and maintained a high rate of protocol compliance.
NCT02020863.
目标导向液体治疗（GDFT）已被证明可改善中、高风险手术的预后。然而，目前大多数基于心输出量优化的GDFT方案使用侵入性设备，且这些方案可能需要医生密切关注并进行大量干预才能准确应用。这项前瞻性初步研究的目的是评估使用带有无创心输出量监测设备（Nexfin™，BMEYE，荷兰阿姆斯特丹）的闭环液体输注系统进行GDFT的临床可行性。
纳入计划在全身麻醉下进行择期中度风险手术的患者。负责该病例的主要麻醉团队使用控制器界面选择GDFT目标，所有患者均接受3 ml·kg⁻¹·h⁻¹的晶体液基础输注。胶体溶液由闭环系统根据Nexfin™监测器的数据进行输注，以扩充血管内容量。当患者在预负荷独立状态（定义为脉压变异<13%）下度过超过85%的手术时间，或手术期间平均心脏指数>2.5升·分钟⁻¹·米⁻²时，GDFT管理的依从性被定义为可接受。
研究组共纳入13例患者。所有患者在超过85%的病例时间内均符合GDFT的既定标准。住院时间中位数为5[3 - 6]天。
在这项初步研究中，使用带有无创心输出量监测设备的闭环液体输注系统进行GDFT管理是可行的，且维持了较高的方案依从率。
NCT02020863。
