Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.12.012
Brazilian Journal of Anesthesiology
Original Investigation

Perioperative goal-directed fluid management using noninvasive hemodynamic monitoring in gynecologic oncology

Gerenciamento de fluidos perioperatório direcionado por metas usando monitoramento hemodinâmico não invasivo em oncologia ginecológica

Gunes O.Yildiza Gulsum O.Hergunsel, Gokhan Sertcakacilar, Duygu Akyol, Sema Karakaş, Zafer Cukurova

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Abstract

Background: Intraoperative fluid management is important for the prevention of perioperative morbidity and mortality. Our study aimed to investigate the perioperative feasibility and benefits of Goal-Directed Fluid Management (GDFM) using noninvasive hemodynamic monitoring in gynecologic oncology patients with acute blood loss and severe fluid loss. We assessed the effects of GDFM on hemodynamics, organ perfusion, complications, and mortality outcomes.
Methods: This randomized prospective study included 104 patients over the age of 18 years, including 56 patients with endometrial cancer and 48 patients with ovarian cancer who had open surgery. The anesthetic approach was standardized for all patients. We compared the perioperative results of the subjects who were randomized into GDFM (n = 51) and Liberal Fluid Management (LFM) (n = 53) groups using a computer program.
Results: The median perioperative crystalloid replacement (2000 vs. 2700; p < 0.001) and total volume of fluid (2260 vs. 3200; p < 0.001) were lower in the GDFM group compared to the LFM group. The hemodynamic findings and the HCO3 and lactate levels of the GDFM group did not significantly change perioperatively. The heart rate, mean arterial pressure, and HCO3 levels of the LFM group decreased and serum lactate levels increased perioperatively. The hospitalization rate in ICU (7.8% vs. 28.3%; p = 0.010), rate of patients with comorbidity conditions indicated in ICU (2% vs. 17%; p = 0.024), and rate of complications (17.6% vs. 35.8%; p = 0.047) were lower in
the GDFM group compared to the LFM group.

Conclusion: The amount of intraoperatively administered crystalloid solution and complication rates were significantly lower in gynecologic oncologic surgery patients who received GDFM. Besides, hemodynamic findings, and lactate levels of the GDFM group did not change significantly
during the perioperative period.

Keywords

Fluid therapy; Hemodynamic monitoring; Goal-directed fluid therapy; Gynecologic debulking surgery

Resumo

Justificativa: O gerenciamento de fluidos intraoperatório é importante para a prevenção da morbidade e mortalidade perioperatória. Nosso estudo teve como objetivo investigar a viabilidade perioperatória e os benefícios do gerenciamento de fluido direcionado por metas (GFDM) usando monitoramento hemodinâmico não invasivo em pacientes oncológicos ginecológicos com perda aguda de sangue e perda grave de fluido. Avaliamos os efeitos do GFDM na hemodinâmica, perfusão de órgãos, complicações e desfechos de mortalidade. Métodos: Este estudo prospectivo randomizado incluiu 104 pacientes com idade superior a 18 anos, incluindo 56 pacientes com câncer de endométrio e 48 pacientes com câncer de ovário submetidas à cirurgia aberta. A abordagem anestésica foi padronizada para todos os pacientes. Comparamos os resultados perioperatórios dos indivíduos que foram randomizados em grupos GFDM (n = 51) e gerenciamento liberal de fluidos (GLF) (n = 53) usando um programa de computador. Resultados: A mediana de reposição cristalóide perioperatória (2000 vs. 2700; p < 0,001) e volume total de líquido (2260 vs. 3200; p < 0,001) foram menores no grupo GFDM em comparação ao grupo GLF. Os achados hemodinâmicos e os níveis de HCO3 e lactato do grupo GFDM não mudaram significativamente no perioperatório. A frequência cardíaca, pressão arterial média e níveis de HCO3 do grupo GLF diminuíram e os níveis séricos de lactato aumentaram no perioperatório. A taxa de internação em UTI (7,8% vs. 28,3%; p = 0,010), taxa de pacientes com comorbidades indicadas em UTI (2% vs. %17; p = 0,024) e taxa de complicações (17,6% vs. 35,8 %; p = 0,047) foram menores no grupo GFDM em comparação ao grupo GLF. Conclusão: A quantidade de solução cristaloide administrada no intraoperatório e as taxas de complicações foram significativamente menores em pacientes de cirurgia oncológica ginecológica que receberam GFDM. Além disso, os achados hemodinâmicos e os níveis de lactato do grupo GFDM não se alteraram significativamente durante o período perioperatório.

Palavras-chave

Fluidoterapia; Monitorização hemodinâmica; Fluidoterapia direcionada a objetivos; Cirurgia ginecológica citorredutora

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Submitted date:
02/09/2021

Accepted date:
12/26/2021

621699fea953951a3b1b65c2 rba Articles
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