Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]
By R. Pearse, D. Dawson, J. Fawcett, A. Rhodes, M. Grounds, D. Bennett. Critical Care, 2005
639 citations recorded by the source corpus.
IntroductionGoal-directed therapy (GDT) has been shown to improve outcome when commenced before surgery. This requires pre-operative admission to the intensive care unit (ICU). In cardiac surgery, GDT has proved effective when commenced after surgery. The aim of this study was to evaluate the effect of post-operative GDT on the incidence of complications and duration of hospital stay in patients undergoing general surgery.MethodsThis was a randomised controlled trial with concealed allocation. High-risk general surgical patients were allocated to post-operative GDT to attain an oxygen delivery index of 600 ml min-1 m-2 or to conventional management. Cardiac output was measured by lithium indicator dilution and pulse power analysis. Patients were followed up for 60 days.ResultsSixty-two patients were randomised to GDT and 60 patients to control treatment. The GDT group received more intravenous colloid (1,907 SD ± 878 ml versus 1,204 SD ± 898 ml; p < 0.0001) and dopexamine (55 patients (89%) versus 1 patient (2%); p < 0.0001). Fewer GDT patients developed complications (27 patients (44%) versus 41 patients (68%); p = 0.003, relative risk 0.63; 95% confidence intervals 0.46 to 0.87). The number of complications per patient was also reduced (0.7 SD ± 0.9 per patient versus 1.5 SD ± 1.5 per patient; p = 0.002). The median duration of hospital stay in the GDT group was significantly reduced (11 days (IQR 7 to 15) versus 14 days (IQR 11 to 27); p = 0.001). There was no significant difference in mortality (seven patients (11.3%) versus nine patients (15%); p = 0.59).ConclusionPost-operative GDT is associated with reductions in post-operative complications and duration of hospital stay. The beneficial effects of GDT may be achieved while avoiding the difficulties of pre-operative ICU admission.
Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Surgery
View Paper: https://www.semanticscholar.org/paper/c07298fe9e147057a1ce3827f79ffafc92f440b2
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Citations in the corpus
- Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial (2017, background): “Blood Pressure and Intraoperative Management Throughout surgery, the mean (SD) SBP was 123 (25) mm Hg in the individualized treatment group and 116 (24) mm Hg in the standard treatment group (Figure 2; eFigure 1 and eFigure 2 in Supplement 2); the between-group difference was 6.”
- A Systematic Review and Meta-Analysis on the Use of Preemptive Hemodynamic Intervention to Improve Postoperative Outcomes in Moderate and High-Risk Surgical Patients (2011, background): “We defined this group according to criteria previously published by Shoemaker et al.11 and later modified by Pearse et al.15”
- The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm (2018, background): “Whereas studies focused on the care of patients with an aortic aneurysm have not been conducted, randomized trials have included patients with vascular disease.(604)”