Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation: A retrospective study
Liver transplantation carries major risks during the perioperative period. Few studies focused on the hemodynamics of patients undergoing liver transplantation. The present study was aimed to evaluate the impact of the implementation of a protocol including goal-directed therapy in patients undergoi...
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| Veröffentlicht in: | Annales françaises d'anesthésie et de réanimation 2014-04, Vol.33 (4), p.e47-e54 |
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| creator | Reydellet, L. Blasco, V. Mercier, M.-F. Antonini, F. Nafati, C. Harti-Souab, K. Leone, M. Albanese, J. |
| description | Liver transplantation carries major risks during the perioperative period. Few studies focused on the hemodynamics of patients undergoing liver transplantation. The present study was aimed to evaluate the impact of the implementation of a protocol including goal-directed therapy in patients undergoing liver transplantation. Our first goal was to determine its impact on the fluid balance. Secondarily, we evaluated possible improvements in the patient outcomes.
A before and after study.
Fifty patients undergoing liver transplantation were included during two successive six-month periods. During the first period, the management of the patients was left at the discretion of the senior physicians (control group, n=25). During the second period, the patients were treated according to a predetermined protocol including a specific hemodynamic monitoring (protocol group, n=25).
The fluid balance was negative in the protocol group and positive in the control group at 24h (−606mL vs. +3445mL, P |
| doi_str_mv | 10.1016/j.annfar.2013.12.016 |
| format | Article |
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A before and after study.
Fifty patients undergoing liver transplantation were included during two successive six-month periods. During the first period, the management of the patients was left at the discretion of the senior physicians (control group, n=25). During the second period, the patients were treated according to a predetermined protocol including a specific hemodynamic monitoring (protocol group, n=25).
The fluid balance was negative in the protocol group and positive in the control group at 24h (−606mL vs. +3445mL, P<0.01) and 48h (−2315mL vs. +1170mL, P<0.01) after liver transplantation. The volume of the crystalloid administration was lower in the protocol group than in the control group (5000mL vs. 8000mL, P<0.01, and 1500mL vs. 6000mL, P<0.01, during surgery and 48h after liver transplantation, respectively). The duration of mechanical ventilation and postoperative ileus were significantly reduced in the protocol group, as compared with the control group, 20h vs. 94h (P<0.01) and 4days vs. 6days (P<0.01), respectively.
For patients undergoing liver transplantation, the implementation of a protocol aiming to optimize hemodynamics was associated with reduced fluid balance and decreased requirement for mechanical ventilation and postoperative ileus duration.
La transplantation hépatique est une chirurgie à haut risque périopératoire. Peu d’études se sont intéressées à la gestion hémodynamique des patients bénéficiant d’une transplantation hépatique. Le but de notre étude était d’évaluer l’impact d’un protocole d’optimisation hémodynamique périopératoire sur la balance hydrique. Les objectifs secondaires étaient d’étudier les conséquences sur les durées de ventilation, d’iléus, de séjour et sur la morbi-mortalité postopératoire.
Étude avant–après.
Cinquante patients bénéficiant d’une transplantation hépatique ont été inclus pendant deux périodes successives de 6 mois. Pendant la première période, la gestion hémodynamique et transfusionnelle des patients était libre (groupe témoin, n=25). Pendant la seconde période, un protocole d’optimisation hémodynamique avec des objectifs précis et une réduction des apports hydriques de base a été mis en place (groupe protocole, n=25).
La balance hydrique était négative dans le groupe protocole et positive dans le groupe témoin à 24heures (−606mL vs. +3445mL, p<0,01) et à 48heures (−2315mL vs. +1170mL, p<0,01) après la transplantation hépatique. Le volume de cristalloïdes administré était plus faible dans le groupe protocole que dans le groupe témoin en peropératoire (5000mL vs. 8000mL, p<0,01) mais aussi pendant les 48heures postopératoires (1500mL vs. 6000mL, p<0,01). Les durées de ventilation mécanique et d’iléus postopératoire étaient significativement réduites dans le groupe protocole, 20h vs. 94h (p<0,01) et 4jours vs. 6jours (p<0,01), respectivement.
Chez les patients bénéficiant d’une transplantation hépatique, l’utilisation d’un protocole de monitorage et d’optimisation hémodynamique était associée à une réduction de la balance hydrique périopératoire ainsi qu’une réduction des durées de ventilation mécanique et d’iléus postopératoire.]]></description><identifier>ISSN: 0750-7658</identifier><identifier>EISSN: 1769-6623</identifier><identifier>DOI: 10.1016/j.annfar.2013.12.016</identifier><identifier>PMID: 24456618</identifier><language>eng</language><publisher>France: Elsevier SAS</publisher><subject>Balance hydrique ; Blood Transfusion ; Cirrhose ; Cirrhosis ; Clinical Protocols ; Female ; Fluid balance ; Fluid Therapy ; Goal-directed therapy ; Goals ; Hemodynamic ; Hemodynamics - physiology ; Humans ; Liver transplantation ; Liver Transplantation - methods ; Male ; Middle Aged ; Postoperative Period ; Protocole hémodynamique ; Retrospective Studies ; Transplantation hépatique ; Treatment Outcome ; Water-Electrolyte Balance - physiology</subject><ispartof>Annales françaises d'anesthésie et de réanimation, 2014-04, Vol.33 (4), p.e47-e54</ispartof><rights>2013 Société française d’anesthésie et de réanimation (Sfar)</rights><rights>Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c277t-437695b1f5b4a95182ad26f14b3d4daf62d33160e42f7f21c39da50d9e2667433</citedby><cites>FETCH-LOGICAL-c277t-437695b1f5b4a95182ad26f14b3d4daf62d33160e42f7f21c39da50d9e2667433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.annfar.2013.12.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3541,27915,27916,45986</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24456618$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reydellet, L.</creatorcontrib><creatorcontrib>Blasco, V.</creatorcontrib><creatorcontrib>Mercier, M.-F.</creatorcontrib><creatorcontrib>Antonini, F.</creatorcontrib><creatorcontrib>Nafati, C.</creatorcontrib><creatorcontrib>Harti-Souab, K.</creatorcontrib><creatorcontrib>Leone, M.</creatorcontrib><creatorcontrib>Albanese, J.</creatorcontrib><title>Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation: A retrospective study</title><title>Annales françaises d'anesthésie et de réanimation</title><addtitle>Ann Fr Anesth Reanim</addtitle><description><![CDATA[Liver transplantation carries major risks during the perioperative period. Few studies focused on the hemodynamics of patients undergoing liver transplantation. The present study was aimed to evaluate the impact of the implementation of a protocol including goal-directed therapy in patients undergoing liver transplantation. Our first goal was to determine its impact on the fluid balance. Secondarily, we evaluated possible improvements in the patient outcomes.
A before and after study.
Fifty patients undergoing liver transplantation were included during two successive six-month periods. During the first period, the management of the patients was left at the discretion of the senior physicians (control group, n=25). During the second period, the patients were treated according to a predetermined protocol including a specific hemodynamic monitoring (protocol group, n=25).
The fluid balance was negative in the protocol group and positive in the control group at 24h (−606mL vs. +3445mL, P<0.01) and 48h (−2315mL vs. +1170mL, P<0.01) after liver transplantation. The volume of the crystalloid administration was lower in the protocol group than in the control group (5000mL vs. 8000mL, P<0.01, and 1500mL vs. 6000mL, P<0.01, during surgery and 48h after liver transplantation, respectively). The duration of mechanical ventilation and postoperative ileus were significantly reduced in the protocol group, as compared with the control group, 20h vs. 94h (P<0.01) and 4days vs. 6days (P<0.01), respectively.
For patients undergoing liver transplantation, the implementation of a protocol aiming to optimize hemodynamics was associated with reduced fluid balance and decreased requirement for mechanical ventilation and postoperative ileus duration.
La transplantation hépatique est une chirurgie à haut risque périopératoire. Peu d’études se sont intéressées à la gestion hémodynamique des patients bénéficiant d’une transplantation hépatique. Le but de notre étude était d’évaluer l’impact d’un protocole d’optimisation hémodynamique périopératoire sur la balance hydrique. Les objectifs secondaires étaient d’étudier les conséquences sur les durées de ventilation, d’iléus, de séjour et sur la morbi-mortalité postopératoire.
Étude avant–après.
Cinquante patients bénéficiant d’une transplantation hépatique ont été inclus pendant deux périodes successives de 6 mois. Pendant la première période, la gestion hémodynamique et transfusionnelle des patients était libre (groupe témoin, n=25). Pendant la seconde période, un protocole d’optimisation hémodynamique avec des objectifs précis et une réduction des apports hydriques de base a été mis en place (groupe protocole, n=25).
La balance hydrique était négative dans le groupe protocole et positive dans le groupe témoin à 24heures (−606mL vs. +3445mL, p<0,01) et à 48heures (−2315mL vs. +1170mL, p<0,01) après la transplantation hépatique. Le volume de cristalloïdes administré était plus faible dans le groupe protocole que dans le groupe témoin en peropératoire (5000mL vs. 8000mL, p<0,01) mais aussi pendant les 48heures postopératoires (1500mL vs. 6000mL, p<0,01). Les durées de ventilation mécanique et d’iléus postopératoire étaient significativement réduites dans le groupe protocole, 20h vs. 94h (p<0,01) et 4jours vs. 6jours (p<0,01), respectivement.
Chez les patients bénéficiant d’une transplantation hépatique, l’utilisation d’un protocole de monitorage et d’optimisation hémodynamique était associée à une réduction de la balance hydrique périopératoire ainsi qu’une réduction des durées de ventilation mécanique et d’iléus postopératoire.]]></description><subject>Balance hydrique</subject><subject>Blood Transfusion</subject><subject>Cirrhose</subject><subject>Cirrhosis</subject><subject>Clinical Protocols</subject><subject>Female</subject><subject>Fluid balance</subject><subject>Fluid Therapy</subject><subject>Goal-directed therapy</subject><subject>Goals</subject><subject>Hemodynamic</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Protocole hémodynamique</subject><subject>Retrospective Studies</subject><subject>Transplantation hépatique</subject><subject>Treatment Outcome</subject><subject>Water-Electrolyte Balance - physiology</subject><issn>0750-7658</issn><issn>1769-6623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2KFDEUhYMoTjv6BiJZuqky_9XlQhgGfwYG3Og6pJKbNk11UiapgX6IeWfT1OjSVeDku_fccy9CbynpKaHqw7E3MXqTe0Yo7ynrm_gM7eigxk4pxp-jHRkk6QYl91foVSlHQojkgr5EV0wIqRTd79Dj3WkxtuLkscGHZObOhQy2gsP1F2SznPGSU002zThFvKRS09L0Gh4A-3kNDk9mNtECDu276RBrwWt0kA8pxAOeG5lxzSaWpYG1ISl-xDc4Q82pLM3s0qvU1Z1foxfezAXePL3X6OeXzz9uv3X337_e3d7cd5YNQ-0EbyHlRL2chBkl3TPjmPJUTNwJZ7xijnOqCAjmB8-o5aMzkrgRmFKD4Pwavd_6tmy_VyhVn0KxMLf5IK1FU8m4IHwkF1RsqG3DlgxeLzmcTD5rSvTlEPqot0PoyyE0ZbqJrezdk8M6ncD9K_q7-QZ82gBoOR8CZF1s252Fbf_apfB_hz-SXZ58</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Reydellet, L.</creator><creator>Blasco, V.</creator><creator>Mercier, M.-F.</creator><creator>Antonini, F.</creator><creator>Nafati, C.</creator><creator>Harti-Souab, K.</creator><creator>Leone, M.</creator><creator>Albanese, J.</creator><general>Elsevier SAS</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201404</creationdate><title>Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation: A retrospective study</title><author>Reydellet, L. ; Blasco, V. ; Mercier, M.-F. ; Antonini, F. ; Nafati, C. ; Harti-Souab, K. ; Leone, M. ; Albanese, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c277t-437695b1f5b4a95182ad26f14b3d4daf62d33160e42f7f21c39da50d9e2667433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Balance hydrique</topic><topic>Blood Transfusion</topic><topic>Cirrhose</topic><topic>Cirrhosis</topic><topic>Clinical Protocols</topic><topic>Female</topic><topic>Fluid balance</topic><topic>Fluid Therapy</topic><topic>Goal-directed therapy</topic><topic>Goals</topic><topic>Hemodynamic</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Protocole hémodynamique</topic><topic>Retrospective Studies</topic><topic>Transplantation hépatique</topic><topic>Treatment Outcome</topic><topic>Water-Electrolyte Balance - physiology</topic><toplevel>online_resources</toplevel><creatorcontrib>Reydellet, L.</creatorcontrib><creatorcontrib>Blasco, V.</creatorcontrib><creatorcontrib>Mercier, M.-F.</creatorcontrib><creatorcontrib>Antonini, F.</creatorcontrib><creatorcontrib>Nafati, C.</creatorcontrib><creatorcontrib>Harti-Souab, K.</creatorcontrib><creatorcontrib>Leone, M.</creatorcontrib><creatorcontrib>Albanese, J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annales françaises d'anesthésie et de réanimation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reydellet, L.</au><au>Blasco, V.</au><au>Mercier, M.-F.</au><au>Antonini, F.</au><au>Nafati, C.</au><au>Harti-Souab, K.</au><au>Leone, M.</au><au>Albanese, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation: A retrospective study</atitle><jtitle>Annales françaises d'anesthésie et de réanimation</jtitle><addtitle>Ann Fr Anesth Reanim</addtitle><date>2014-04</date><risdate>2014</risdate><volume>33</volume><issue>4</issue><spage>e47</spage><epage>e54</epage><pages>e47-e54</pages><issn>0750-7658</issn><eissn>1769-6623</eissn><abstract><![CDATA[Liver transplantation carries major risks during the perioperative period. Few studies focused on the hemodynamics of patients undergoing liver transplantation. The present study was aimed to evaluate the impact of the implementation of a protocol including goal-directed therapy in patients undergoing liver transplantation. Our first goal was to determine its impact on the fluid balance. Secondarily, we evaluated possible improvements in the patient outcomes.
A before and after study.
Fifty patients undergoing liver transplantation were included during two successive six-month periods. During the first period, the management of the patients was left at the discretion of the senior physicians (control group, n=25). During the second period, the patients were treated according to a predetermined protocol including a specific hemodynamic monitoring (protocol group, n=25).
The fluid balance was negative in the protocol group and positive in the control group at 24h (−606mL vs. +3445mL, P<0.01) and 48h (−2315mL vs. +1170mL, P<0.01) after liver transplantation. The volume of the crystalloid administration was lower in the protocol group than in the control group (5000mL vs. 8000mL, P<0.01, and 1500mL vs. 6000mL, P<0.01, during surgery and 48h after liver transplantation, respectively). The duration of mechanical ventilation and postoperative ileus were significantly reduced in the protocol group, as compared with the control group, 20h vs. 94h (P<0.01) and 4days vs. 6days (P<0.01), respectively.
For patients undergoing liver transplantation, the implementation of a protocol aiming to optimize hemodynamics was associated with reduced fluid balance and decreased requirement for mechanical ventilation and postoperative ileus duration.
La transplantation hépatique est une chirurgie à haut risque périopératoire. Peu d’études se sont intéressées à la gestion hémodynamique des patients bénéficiant d’une transplantation hépatique. Le but de notre étude était d’évaluer l’impact d’un protocole d’optimisation hémodynamique périopératoire sur la balance hydrique. Les objectifs secondaires étaient d’étudier les conséquences sur les durées de ventilation, d’iléus, de séjour et sur la morbi-mortalité postopératoire.
Étude avant–après.
Cinquante patients bénéficiant d’une transplantation hépatique ont été inclus pendant deux périodes successives de 6 mois. Pendant la première période, la gestion hémodynamique et transfusionnelle des patients était libre (groupe témoin, n=25). Pendant la seconde période, un protocole d’optimisation hémodynamique avec des objectifs précis et une réduction des apports hydriques de base a été mis en place (groupe protocole, n=25).
La balance hydrique était négative dans le groupe protocole et positive dans le groupe témoin à 24heures (−606mL vs. +3445mL, p<0,01) et à 48heures (−2315mL vs. +1170mL, p<0,01) après la transplantation hépatique. Le volume de cristalloïdes administré était plus faible dans le groupe protocole que dans le groupe témoin en peropératoire (5000mL vs. 8000mL, p<0,01) mais aussi pendant les 48heures postopératoires (1500mL vs. 6000mL, p<0,01). Les durées de ventilation mécanique et d’iléus postopératoire étaient significativement réduites dans le groupe protocole, 20h vs. 94h (p<0,01) et 4jours vs. 6jours (p<0,01), respectivement.
Chez les patients bénéficiant d’une transplantation hépatique, l’utilisation d’un protocole de monitorage et d’optimisation hémodynamique était associée à une réduction de la balance hydrique périopératoire ainsi qu’une réduction des durées de ventilation mécanique et d’iléus postopératoire.]]></abstract><cop>France</cop><pub>Elsevier SAS</pub><pmid>24456618</pmid><doi>10.1016/j.annfar.2013.12.016</doi></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0750-7658 |
| ispartof | Annales françaises d'anesthésie et de réanimation, 2014-04, Vol.33 (4), p.e47-e54 |
| issn | 0750-7658 1769-6623 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1523403903 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Balance hydrique Blood Transfusion Cirrhose Cirrhosis Clinical Protocols Female Fluid balance Fluid Therapy Goal-directed therapy Goals Hemodynamic Hemodynamics - physiology Humans Liver transplantation Liver Transplantation - methods Male Middle Aged Postoperative Period Protocole hémodynamique Retrospective Studies Transplantation hépatique Treatment Outcome Water-Electrolyte Balance - physiology |
| title | Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation: A retrospective study |
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