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Br J Anaesth. 2017 Jun 1;118(6):852-861. doi: 10.1093/bja/aew447.

Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial.

Author information

1
Department of Anaesthesiology and Critical Care.
2
IMBI, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany.
3
Department of Thoracic Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg, Germany.

Abstract

Background:

Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial.

Methods:

One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment.

Results:

Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P  = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min - 1 m  - 2 ]; P  < 0.001) and stroke volume index (43 vs. 34 [ml m 2 ]; P  < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P  = 0.005).

Conclusions:

Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay.

Clinical trial registration.:

The study was registered in the German Clinical Trials Register (DRKS 00006961). https://drks-neu.uniklinik-freiburg.de/drks_web/.

KEYWORDS:

hemodynamics; postoperative complications; thoracic surgery

Comment in

PMID:
28575331
DOI:
10.1093/bja/aew447
[Indexed for MEDLINE]
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