UNICAEN, service d'anesthésie réanimation, Normandie université, CHU de Caen Normandie, 14000 Caen, France.
UNICAEN, service d'anesthésie réanimation, Normandie université, CHU de Caen Normandie, 14000 Caen, France.
Anaesth Crit Care Pain Med. 2020 Jun;39(3):421-428. doi: 10.1016/j.accpm.2020.03.016. Epub 2020 Mar 27.
The present study aimed at evaluating the effect of a haemodynamic algorithm using SV maximisation by non-invasive photoplethysmography (interventional group) on the incidence of postoperative complications compared with a control group using intermittent mean arterial pressure.
The non-blinded parallel-group trial randomised low-risk patients undergoing colorectal surgery into either interventional group or control group. The primary outcome was the incidence of patients with at least one complication during the 30 days following surgery. The secondary outcomes were the total number of complications, the length of hospital stay and postoperative mortality. A meta-analysis of randomised trials comparing perioperative haemodynamic optimisation (interventional group) using photoplethysmography with control group was performed to assess the external validity.
Among 160 randomised patients, 159 were analysed (80 and 79 in interventional and control groups, respectively). Demographic characteristics were similar in both groups. Postoperative complications occurred in 40 (50%) and 34 (43%) patients in the interventional and control groups, respectively (P=0.471). There were no significant differences between the two groups regarding the total number of complications (P=0.078), the hospital length of stay (P=0.960), or postoperative mortality (P=1.000). In the meta-analysis including 1089 patients in 7 randomised controlled studies, 203 (38%) and 221 (40%) patients suffered from at least one complication following surgery [risk ratio 0.89 (95% CI 0.68-1.17), P=0.407] in interventional and control groups, respectively.
Based on the findings of the present study and meta-analysis, a haemodynamic perioperative algorithm using SV maximisation by non-invasive photoplethysmography cannot reduce postoperative morbidity.
本研究旨在评估通过非侵入性光体积描记术（干预组）最大化 SV 的血流动力学算法与使用间歇平均动脉压的对照组相比，对术后并发症发生率的影响。
本非盲平行组试验将接受结直肠手术的低危患者随机分为干预组或对照组。主要结局是术后 30 天内至少有一名患者发生并发症的发生率。次要结局是总并发症数、住院时间和术后死亡率。对比较使用光体积描记术进行围手术期血流动力学优化（干预组）与对照组的随机试验进行荟萃分析，以评估外部有效性。
在 160 名随机患者中，有 159 名进行了分析（干预组和对照组分别为 80 名和 79 名）。两组的人口统计学特征相似。术后并发症分别发生在干预组和对照组的 40（50%）和 34（43%）名患者中（P=0.471）。两组之间总并发症数（P=0.078）、住院时间（P=0.960）或术后死亡率（P=1.000）无显著差异。在包括 7 项随机对照研究的 1089 名患者的荟萃分析中，203（38%）和 221（40%）名患者在手术后至少发生了一次并发症[风险比 0.89（95%CI 0.68-1.17），P=0.407]在干预组和对照组中，分别。
根据本研究和荟萃分析的结果，使用非侵入性光体积描记术最大化 SV 的围手术期血流动力学算法不能降低术后发病率。
