Fluid therapy and pulmonary complications in abdominal surgeries: randomized controlled trial
Fluidoterapia e complicações pulmonares em cirurgias abdominais: ensaio clínico randomizado
Gabriel Isaac Pereira de Castro, Renata Sayuri Ansai Pereira de Castro, Rodrigo Moreira e Lima, Bruna Nogueira dos Santos, Lais Helena Navarro e Lima
Abstract
Background
There is no consensus on the most effective strategy for Postoperative Pulmonary Complication (PPC) reduction. This study hypothesized that a Goal-Directed Fluid Therapy (GDFT) protocol of infusion of predetermined boluses reduces the occurrence of PPC in patients undergoing elective open abdominal surgeries when compared with Standard of Care (SOC) strategy.
Methods
Randomized, prospective, controlled study, conducted from May 2012 to December 2014, with ASA I, II or III patients undergoing open abdominal surgeries, lasting at least 120 min, under general anesthesia, randomized into the SOC and the GDFT group. In the SOC, fluid administration was according to the anesthesiologist's discretion. In the GDFT, the intervention protocol, based on bolus infusion according to blood pressure and delta pulse pressure, was applied. Patients were postoperatively evaluated by an anesthesiologist blinded to the group allocation regarding PPC incidence, mortality, and Length of Hospital Stay (LOHS).
Results
Forty-two patients in the SOC group and 43 in the GDFT group. Nineteen patients (45%) in the SOC and 6 in the GDFT (14%) had at least one PPC (p = 0.003). There was no difference in mortality or LOHS between the groups. Among the patients with PPC, four died (25%), compared to two deaths in patients without PPC (3%) (p = 0.001). The LOHS had a median of 14.5 days in the group with PPC and 9 days in the group without PPC (p = 0.001).
Conclusion
The GDFT protocol resulted in a lower rate of PPC; however, the LOHS and mortality did not reduce.
Keywords
Resumo
Introdução
Não há consenso sobre a estratégia mais eficaz para redução de complicações pulmonares pós-operatórias (CPP). Este estudo levantou a hipótese de que um protocolo de fluidoterapia direcionada por metas (GDFT) de infusão de bolus predeterminados reduz a ocorrência de PPC em pacientes submetidos a cirurgias abdominais abertas eletivas quando comparado com a estratégia Standard of Care (SOC).
Métodos
Estudo randomizado, prospectivo e controlado, realizado de maio de 2012 a dezembro de 2014, com pacientes ASA I, II ou III submetidos a cirurgias abdominais abertas, com duração mínima de 120 min, sob anestesia geral, randomizados em grupo SOC e grupo GDFT. No SOC, a administração de fluidos ficou a critério do anestesiologista. No GDFT foi aplicado o protocolo de intervenção, baseado na infusão em bolus de acordo com a pressão arterial e delta da pressão de pulso. Os pacientes foram avaliados no pós-operatório por um anestesiologista que desconhecia a alocação do grupo em relação à incidência de CPP, mortalidade e tempo de internação hospitalar (LOHS).
Resultados
Quarenta e dois pacientes no grupo SOC e 43 no grupo GDFT. Dezenove pacientes (45%) no SOC e 6 no GDFT (14%) apresentaram pelo menos um CPP (p = 0,003). Não houve diferença na mortalidade ou LOHS entre os grupos. Entre os pacientes com CPP, quatro morreram (25%), em comparação com duas mortes em pacientes sem CPP (3%) (p = 0,001). O LOHS teve mediana de 14,5 dias no grupo com CPP e 9 dias no grupo sem CPP (p = 0,001).
Conclusão
O protocolo GDFT resultou em menor taxa de CPP; no entanto, o LOHS e a mortalidade não diminuíram.
Palavras-chave
References
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Submitted date:
08/27/2023
Accepted date:
03/14/2024
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