Randomized controlled trial of stroke volume optimization during elective major abdominal surgery in patients stratified by aerobic fitness
dc.contributor.author | Lai, C | |
dc.contributor.author | Starkie, T | |
dc.contributor.author | Creanor, Siobhan | |
dc.contributor.author | Struthers, R | |
dc.contributor.author | Mellor, N | |
dc.contributor.author | Hosie, K | |
dc.contributor.author | Sneyd, John | |
dc.contributor.author | Minto, G | |
dc.date.accessioned | 2017-01-23T10:10:18Z | |
dc.date.available | 2017-01-23T10:10:18Z | |
dc.date.issued | 2015-10-01 | |
dc.identifier.issn | 0007-0912 | |
dc.identifier.issn | 1471-6771 | |
dc.identifier.uri | http://hdl.handle.net/10026.1/8290 | |
dc.description.abstract |
Abstract BACKGROUND: The benefits of stroke volume optimization during surgery are unclear, with recent data not replicating the positive effects of earlier studies. METHODS: This was a randomized controlled trial of standard fluid therapy with or without supplementary blinded intraoperative stroke volume optimization in 220 patients having major elective rectal resection or cystectomy with ileal conduit. All patients were treated using a contemporary enhanced recovery pathway. Interventional fluid challenges used Gelofusine (B Braun, Germany), guided by stoke volume variability measured by LiDCOrapid (LiDCO, UK). Participants were stratified by aerobic fitness (characterized by preoperative cardiopulmonary exercise test), surgical specialty, and intended surgical approach (open or laparoscopic). The primary outcome was the prevalence of moderate or severe complications on day 5 after surgery, defined using the postoperative morbidity survey (POMS) criteria. RESULTS: Patients received ∼13 ml kg(-1) h(-1) of i.v. fluids during surgery. The intervention group received an additional mean (sd) 956 (896) ml Gelofusine. There were no statistically significant differences between groups in any primary or secondary end point. A positive POMS on postoperative day 5 was noted in 54 of 111 control subjects (48.6%) and 55 of 109 participants in the intervention group [50.5%; adjusted odds ratio 0.90 (95% confidence interval 0.52-1.57), P=0.717]. Mean (sd) hospital length of stay was 9.6 (6.8) days in the control group and 11.8 (11.5) days in the intervention group (adjusted difference -2.1 (-4.6 to 0.3) days, P=0.091). There was no statistical interaction between stroke volume optimization and aerobic fitness in terms of rate of complications or length of stay. CONCLUSIONS: Algorithm-driven stroke volume optimization is of no benefit when superimposed on a liberal baseline fluid regimen in patients having elective major abdominal surgery, when stratified to minimize differences in fitness and surgical approach between groups. CLINICAL TRIAL REGISTRATION: ISRCTN21597243. | |
dc.format.extent | 578-589 | |
dc.format.medium | ||
dc.language | en | |
dc.language.iso | en | |
dc.publisher | Elsevier BV | |
dc.subject | colorectal surgery | |
dc.subject | exercise test | |
dc.subject | fluid therapy | |
dc.subject | haemodynamics | |
dc.subject | postoperative complications | |
dc.title | Randomized controlled trial of stroke volume optimization during elective major abdominal surgery in patients stratified by aerobic fitness | |
dc.type | journal-article | |
dc.type | Article | |
plymouth.author-url | https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000362305700015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008 | |
plymouth.issue | 4 | |
plymouth.volume | 115 | |
plymouth.publication-status | Published | |
plymouth.journal | British Journal of Anaesthesia | |
dc.identifier.doi | 10.1093/bja/aev299 | |
plymouth.organisational-group | /Plymouth | |
plymouth.organisational-group | /Plymouth/Faculty of Health | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy | |
plymouth.organisational-group | /Plymouth/Research Groups | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Health and Community | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED) | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CBBB | |
plymouth.organisational-group | /Plymouth/Users by role | |
dc.publisher.place | England | |
dcterms.dateAccepted | 2015-06-15 | |
dc.identifier.eissn | 1471-6771 | |
dc.rights.embargoperiod | No embargo | |
rioxxterms.versionofrecord | 10.1093/bja/aev299 | |
rioxxterms.licenseref.uri | http://www.rioxx.net/licenses/all-rights-reserved | |
rioxxterms.licenseref.startdate | 2015-10-01 | |
rioxxterms.type | Journal Article/Review | |
plymouth.oa-location | https://doi.org/10.1093/bja/aev299 |