Zorrilla-Vaca Andres, Cata Juan P, Brown Jessica K, Mehran Reza J, Rice David, Mena Gabriel E
Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston Texas; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2022 Dec;114(6):2059-2065. doi: 10.1016/j.athoracsur.2022.03.070. Epub 2022 Apr 19.
Goal-directed fluid therapy (GDFT) has been proposed as a cornerstone for enhanced recovery after surgery (ERAS) programs, particularly among high-risk patients undergoing high-risk surgery. However, because of the increased advocacy of euvolemia before surgery, the utility of GDFT in the context of ERAS is being questioned. Our primary objective was to determine whether GDFT has any impact on daily postoperative renal outcomes of high-risk patients undergoing thoracic surgery in an ERAS program.
All patients included in this study were at high risk with a baseline glomerular filtration rate (GFR) below 90 mL/min per 1.73 m and assigned to American Society of Anesthesiologists class III or class IV. Patients were categorized into 2 groups according to the intraoperative use of GDFT. The groups were matched in a 1:1 fashion using propensity scores. Our renal outcomes included changes in daily GFRs from the postanesthesia care unit through postoperative day 5.
In total, 451 matched pairs were included in this analysis. Both groups had similar demographic and clinical characteristics. Patients treated with GDFT received more ephedrine (5 [0-15] mg vs 0 [0-15] mg; P = .03) and less volume of fluids (1163 ± 484 mL vs 1246 ± 626 mL; P = .03) compared with those in the standard group. The incidence of acute kidney injury was similar in both groups (5.1% in the GDFT group vs 7.1% in the non-GDFT group; P = .57). Mixed effect analysis showed no significant differences in the trajectory of postoperative GFRs between groups (P = .59).
GDFT does not have an impact on postoperative renal function compared with standard of care among high-risk patients in an ERAS program for thoracic pulmonary surgery.
目标导向液体治疗（GDFT）已被提议作为加速康复外科（ERAS）计划的基石，尤其是在接受高风险手术的高危患者中。然而，由于术前对正常血容量的倡导增加，GDFT在ERAS背景下的效用受到质疑。我们的主要目的是确定GDFT对ERAS计划中接受胸外科手术的高危患者术后每日肾脏结局是否有任何影响。
本研究纳入的所有患者均为高危患者，基线肾小球滤过率（GFR）低于90 mL/（min·1.73 m²），并被分配为美国麻醉医师协会Ⅲ级或Ⅳ级。根据术中是否使用GDFT将患者分为两组。使用倾向评分以1:1的方式对两组进行匹配。我们的肾脏结局包括从麻醉后护理病房到术后第5天每日GFR的变化。
本分析共纳入451对匹配患者。两组具有相似的人口统计学和临床特征。与标准组相比，接受GDFT治疗的患者使用麻黄碱更多（5 [0 - 15] mg对0 [0 - 15] mg；P = .03），液体量更少（1163 ± 484 mL对1246 ± 626 mL；P = .03）。两组急性肾损伤的发生率相似（GDFT组为5.1%，非GDFT组为7.1%；P = .57）。混合效应分析显示两组术后GFR轨迹无显著差异（P = .59）。
在胸科肺手术的ERAS计划中，与高危患者的标准治疗相比，GDFT对术后肾功能没有影响。
