Department of Anaesthesiology and Critical Care.
IMBI, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany.
Br J Anaesth. 2017 Jun 1;118(6):852-861. doi: 10.1093/bja/aew447.
Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial.
One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment.
Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min - 1 m - 2 ]; P < 0.001) and stroke volume index (43 vs. 34 [ml m 2 ]; P < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P = 0.005).
Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay.
CLINICAL TRIAL REGISTRATION.: The study was registered in the German Clinical Trials Register (DRKS 00006961). https://drks-neu.uniklinik-freiburg.de/drks_web/.
肺手术后患者常发生肺部和肾脏并发症。血容量过高或过低可能导致这些并发症。我们假设，基于食道多普勒监测的目标导向血流动力学管理可减少随机临床平行臂试验中的术后肺部并发症。
100 例计划接受胸部手术的患者被随机分配至标准血流动力学管理（对照组）或基于食道多普勒监测的算法指导的目标导向治疗（GDT 组）。主要终点是术后肺部并发症，包括肺活量测定。次要终点包括血流动力学变量、肾脏、心脏和神经系统并发症以及住院时间。评估结果的研究者对分组情况不知情。
每组 48 名患者进行了分析。与对照组相比，GDT 组发生术后肺部并发症（6 例与 15 例；P = 0.047）的患者较少，而两组之间的肺活量测定结果无差异。与对照组相比，GDT 组患者在手术期间的心指数（2.9 比 2.1 [l min - 1 m - 2 ]；P < 0.001）和每搏量指数（43 比 34 [ml m 2 ]；P < 0.001）更高。两组之间的肾脏、心脏和神经系统并发症无差异。与对照组相比，GDT 组的住院时间更短（9 天比 11 天；P = 0.005）。
与标准血流动力学管理相比，食道多普勒监测引导的 GDT 与术后肺部并发症减少和住院时间缩短相关。
该研究在德国临床试验注册中心（DRKS 00006961）注册。https://drks-neu.uniklinik-freiburg.de/drks_web/。
