Cristiana Laici, Lorenzo Gamberini, Giovanni Vitale, Chiara Guizzardi, Matteo Ravaioli, Gaetano La Manna, Giorgia Comai, Stefano Skurzak, Elisabetta Cerutti, Salvatore Di Blasi, Paolo Cerchiara, Fabio Gobbi, Mirella Cimatti, Linda Ramahi, Antonio Siniscalchi
Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
Intern Emerg Med. 2025 Jun 25. doi: 10.1007/s11739-025-04021-2.
Appropriate fluid management is crucial in anesthesiologic management during kidney transplantation (KT). Traditional parameters such as blood pressure and central venous pressure are unreliable and weakly supported by guidelines. Goal-directed fluid therapy (GDT) has emerged as a technique for administering fluids and vasoactive drugs based on algorithms to ensure adequate tissue perfusion. Current data suggest GDT may reduce tissue edema and respiratory complications in KT recipients. This multicenter, single-blind randomized controlled trial compared conventional fluid management strategies with a GDT algorithm using non-invasive pulse pressure contour analysis monitoring (ClearSight®) in KT patients. The primary outcome was the hospital length of stay. Secondary outcomes included postoperative complications, delayed graft function, 90-day graft loss, and intensive care unit (ICU) length of stay. Patients and postoperative care physicians were blinded to group assignments. The study enrolled 181 KT recipients over 32 months. The hospital length of stay did not significantly differ between the groups, with a difference of 0.5 days (95% CI: -2.5 to 5 days). No significant differences were found in surgical and medical complications, delayed graft function, graft loss, or ICU length of stay. In KT recipients, using a GDT algorithm did not result in clinically meaningful differences in hospital stay, complications, or graft dysfunction/loss.
在肾移植（KT）的麻醉管理中，适当的液体管理至关重要。传统参数如血压和中心静脉压不可靠，且缺乏指南的有力支持。目标导向液体治疗（GDT）已成为一种基于算法来输注液体和血管活性药物以确保充足组织灌注的技术。目前的数据表明，GDT可能会减少KT受者的组织水肿和呼吸并发症。这项多中心、单盲随机对照试验将传统液体管理策略与使用无创脉搏压力轮廓分析监测（ClearSight®）的GDT算法在KT患者中进行了比较。主要结局是住院时间。次要结局包括术后并发症、移植肾功能延迟恢复、90天移植肾丢失以及重症监护病房（ICU）住院时间。患者和术后护理医生对分组情况不知情。该研究在32个月内招募了181名KT受者。两组之间的住院时间没有显著差异，相差0.5天（95%CI：-2.5至5天）。在手术和医疗并发症、移植肾功能延迟恢复、移植肾丢失或ICU住院时间方面未发现显著差异。对于KT受者，使用GDT算法在住院时间、并发症或移植肾功能障碍/丢失方面未产生具有临床意义的差异。
