Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients
OBJECTIVETo evaluate the effects of maximizing the oxygen delivery on morbidity and mortality in patients >60 yrs of age and/or with chronic diseases of vital organs who underwent major elective surgery. DESIGNProspective, randomized, controlled trial. SETTINGA 24-bed general intensive care unit...
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| Veröffentlicht in: | Critical care medicine 2000-10, Vol.28 (10), p.3396-3404 |
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| creator | Lobo, Suzana M. A Salgado, Paula F Castillo, Vânia G. T Borim, Aldenis A Polachini, Carlos A Palchetti, José C Brienzi, Sergio L. A de Oliveira, Granville G |
| description | OBJECTIVETo evaluate the effects of maximizing the oxygen delivery on morbidity and mortality in patients >60 yrs of age and/or with chronic diseases of vital organs who underwent major elective surgery.
DESIGNProspective, randomized, controlled trial.
SETTINGA 24-bed general intensive care unit of a teaching hospital.
PATIENTSThirty-seven high-risk patients who underwent major surgery.
INTERVENTIONSThe hemodynamic and oxygen transport variables and outcomes in 18 patients (control group) treated to maintain normal values of oxygen delivery were compared with 19 patients (protocol group) treated to maintain “supranormal” values. Therapy in both groups consisted of volume expansion and, when necessary, dobutamine to reach target values, during the surgery and 24 hrs postoperatively.
MEASUREMENTS AND MAIN RESULTSWe interrupted the study because of a significant difference in the 60-day mortality rate. The mortality rate in the control group was significantly higher when compared with the protocol group (9/18 [50%] vs. 3/19 [15.7%], p < .05). The prevalence of clinical and infectious complications was higher in the control group than in the protocol group (67% and 31% respectively; relative risk, 0.47; 95% confidence interval, 0.226–0.991;p < .05) and there was a trend toward more severe organ dysfunction in nonachievers patients (17/24 [71%] vs. 6/13 [46%], relative risk, 0.65; 95% confidence interval, 0.343–1.237; NS).
CONCLUSIONOlder patients with existing cardiorespiratory illness undergoing major surgery have a reduced morbidity and mortality when dobutamine is used to maximize oxygen transport. |
| doi_str_mv | 10.1097/00003246-200010000-00003 |
| format | Article |
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DESIGNProspective, randomized, controlled trial.
SETTINGA 24-bed general intensive care unit of a teaching hospital.
PATIENTSThirty-seven high-risk patients who underwent major surgery.
INTERVENTIONSThe hemodynamic and oxygen transport variables and outcomes in 18 patients (control group) treated to maintain normal values of oxygen delivery were compared with 19 patients (protocol group) treated to maintain “supranormal” values. Therapy in both groups consisted of volume expansion and, when necessary, dobutamine to reach target values, during the surgery and 24 hrs postoperatively.
MEASUREMENTS AND MAIN RESULTSWe interrupted the study because of a significant difference in the 60-day mortality rate. The mortality rate in the control group was significantly higher when compared with the protocol group (9/18 [50%] vs. 3/19 [15.7%], p < .05). The prevalence of clinical and infectious complications was higher in the control group than in the protocol group (67% and 31% respectively; relative risk, 0.47; 95% confidence interval, 0.226–0.991;p < .05) and there was a trend toward more severe organ dysfunction in nonachievers patients (17/24 [71%] vs. 6/13 [46%], relative risk, 0.65; 95% confidence interval, 0.343–1.237; NS).
CONCLUSIONOlder patients with existing cardiorespiratory illness undergoing major surgery have a reduced morbidity and mortality when dobutamine is used to maximize oxygen transport.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-200010000-00003</identifier><identifier>PMID: 11057792</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiotonic Agents - therapeutic use ; Chronic Disease ; Dobutamine - therapeutic use ; Elective Surgical Procedures - adverse effects ; Elective Surgical Procedures - mortality ; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery ; Hemodynamics - drug effects ; Humans ; Intensive care medicine ; Intraoperative Care - methods ; Medical sciences ; Middle Aged ; Morbidity ; Multiple Organ Failure - etiology ; Oxygen Consumption - drug effects ; Postoperative Care - methods ; Prospective Studies ; Survival Analysis ; Time Factors ; Treatment Outcome ; Tropical medicine</subject><ispartof>Critical care medicine, 2000-10, Vol.28 (10), p.3396-3404</ispartof><rights>2000 Lippincott Williams & Wilkins, Inc.</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3853-cb09a4626d2e866a72e79311fb34fcc1082e6801bc33fbc4b085859bd78f8d863</citedby><cites>FETCH-LOGICAL-c3853-cb09a4626d2e866a72e79311fb34fcc1082e6801bc33fbc4b085859bd78f8d863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1534980$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11057792$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lobo, Suzana M. A</creatorcontrib><creatorcontrib>Salgado, Paula F</creatorcontrib><creatorcontrib>Castillo, Vânia G. T</creatorcontrib><creatorcontrib>Borim, Aldenis A</creatorcontrib><creatorcontrib>Polachini, Carlos A</creatorcontrib><creatorcontrib>Palchetti, José C</creatorcontrib><creatorcontrib>Brienzi, Sergio L. A</creatorcontrib><creatorcontrib>de Oliveira, Granville G</creatorcontrib><title>Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVETo evaluate the effects of maximizing the oxygen delivery on morbidity and mortality in patients >60 yrs of age and/or with chronic diseases of vital organs who underwent major elective surgery.
DESIGNProspective, randomized, controlled trial.
SETTINGA 24-bed general intensive care unit of a teaching hospital.
PATIENTSThirty-seven high-risk patients who underwent major surgery.
INTERVENTIONSThe hemodynamic and oxygen transport variables and outcomes in 18 patients (control group) treated to maintain normal values of oxygen delivery were compared with 19 patients (protocol group) treated to maintain “supranormal” values. Therapy in both groups consisted of volume expansion and, when necessary, dobutamine to reach target values, during the surgery and 24 hrs postoperatively.
MEASUREMENTS AND MAIN RESULTSWe interrupted the study because of a significant difference in the 60-day mortality rate. The mortality rate in the control group was significantly higher when compared with the protocol group (9/18 [50%] vs. 3/19 [15.7%], p < .05). The prevalence of clinical and infectious complications was higher in the control group than in the protocol group (67% and 31% respectively; relative risk, 0.47; 95% confidence interval, 0.226–0.991;p < .05) and there was a trend toward more severe organ dysfunction in nonachievers patients (17/24 [71%] vs. 6/13 [46%], relative risk, 0.65; 95% confidence interval, 0.343–1.237; NS).
CONCLUSIONOlder patients with existing cardiorespiratory illness undergoing major surgery have a reduced morbidity and mortality when dobutamine is used to maximize oxygen transport.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>Chronic Disease</subject><subject>Dobutamine - therapeutic use</subject><subject>Elective Surgical Procedures - adverse effects</subject><subject>Elective Surgical Procedures - mortality</subject><subject>Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intraoperative Care - methods</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Multiple Organ Failure - etiology</subject><subject>Oxygen Consumption - drug effects</subject><subject>Postoperative Care - methods</subject><subject>Prospective Studies</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tropical medicine</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1P7CAUhonR6Fz1LxgWxl2vfLQFlsao9yYmbnRNKD3MoLQdoVXHXy_jjLqSDbwnzzkkz0EIU_KXEiXOST6clXXB8oOuU_FZ2kEzWvEcmOK7aEaIIgUvFT9Af1J6zGhZCb6PDigllRCKzZC-cg7smPDgcGfefOfffT_Hw9tqDj1uIfgXiCs89LgbYuNbP66w6dt1Gk1YJ9_jhZ8viujTE05TnHtrAl6a0UM_piO050xIcLy9D9HD9dX95b_i9u7m_-XFbWG5rHhhG6JMWbO6ZSDr2ggGQnFKXcNLZy0lkkEtCW0s566xZUNkJSvVtEI62cqaH6KzzdxlHJ4nSKPufLIQgulhmJIWjAuqZJlBuQFtHFKK4PQy-s7ElaZEr-XqL7n6W-6mlFtPtn9MTQftT-PWZgZOt4BJWYKLprc-_XBV3oUkGSs32OsQRojpKUyvEPUCTBgX-rfd8g_o9ZGF</recordid><startdate>200010</startdate><enddate>200010</enddate><creator>Lobo, Suzana M. A</creator><creator>Salgado, Paula F</creator><creator>Castillo, Vânia G. T</creator><creator>Borim, Aldenis A</creator><creator>Polachini, Carlos A</creator><creator>Palchetti, José C</creator><creator>Brienzi, Sergio L. A</creator><creator>de Oliveira, Granville G</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott</general><scope>IQODW</scope><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>200010</creationdate><title>Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients</title><author>Lobo, Suzana M. A ; Salgado, Paula F ; Castillo, Vânia G. T ; Borim, Aldenis A ; Polachini, Carlos A ; Palchetti, José C ; Brienzi, Sergio L. A ; de Oliveira, Granville G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3853-cb09a4626d2e866a72e79311fb34fcc1082e6801bc33fbc4b085859bd78f8d863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiotonic Agents - therapeutic use</topic><topic>Chronic Disease</topic><topic>Dobutamine - therapeutic use</topic><topic>Elective Surgical Procedures - adverse effects</topic><topic>Elective Surgical Procedures - mortality</topic><topic>Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intraoperative Care - methods</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Multiple Organ Failure - etiology</topic><topic>Oxygen Consumption - drug effects</topic><topic>Postoperative Care - methods</topic><topic>Prospective Studies</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tropical medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lobo, Suzana M. A</creatorcontrib><creatorcontrib>Salgado, Paula F</creatorcontrib><creatorcontrib>Castillo, Vânia G. T</creatorcontrib><creatorcontrib>Borim, Aldenis A</creatorcontrib><creatorcontrib>Polachini, Carlos A</creatorcontrib><creatorcontrib>Palchetti, José C</creatorcontrib><creatorcontrib>Brienzi, Sergio L. A</creatorcontrib><creatorcontrib>de Oliveira, Granville G</creatorcontrib><collection>Pascal-Francis</collection><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>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lobo, Suzana M. A</au><au>Salgado, Paula F</au><au>Castillo, Vânia G. T</au><au>Borim, Aldenis A</au><au>Polachini, Carlos A</au><au>Palchetti, José C</au><au>Brienzi, Sergio L. A</au><au>de Oliveira, Granville G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2000-10</date><risdate>2000</risdate><volume>28</volume><issue>10</issue><spage>3396</spage><epage>3404</epage><pages>3396-3404</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVETo evaluate the effects of maximizing the oxygen delivery on morbidity and mortality in patients >60 yrs of age and/or with chronic diseases of vital organs who underwent major elective surgery.
DESIGNProspective, randomized, controlled trial.
SETTINGA 24-bed general intensive care unit of a teaching hospital.
PATIENTSThirty-seven high-risk patients who underwent major surgery.
INTERVENTIONSThe hemodynamic and oxygen transport variables and outcomes in 18 patients (control group) treated to maintain normal values of oxygen delivery were compared with 19 patients (protocol group) treated to maintain “supranormal” values. Therapy in both groups consisted of volume expansion and, when necessary, dobutamine to reach target values, during the surgery and 24 hrs postoperatively.
MEASUREMENTS AND MAIN RESULTSWe interrupted the study because of a significant difference in the 60-day mortality rate. The mortality rate in the control group was significantly higher when compared with the protocol group (9/18 [50%] vs. 3/19 [15.7%], p < .05). The prevalence of clinical and infectious complications was higher in the control group than in the protocol group (67% and 31% respectively; relative risk, 0.47; 95% confidence interval, 0.226–0.991;p < .05) and there was a trend toward more severe organ dysfunction in nonachievers patients (17/24 [71%] vs. 6/13 [46%], relative risk, 0.65; 95% confidence interval, 0.343–1.237; NS).
CONCLUSIONOlder patients with existing cardiorespiratory illness undergoing major surgery have a reduced morbidity and mortality when dobutamine is used to maximize oxygen transport.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>11057792</pmid><doi>10.1097/00003246-200010000-00003</doi><tpages>9</tpages></addata></record> |
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| ispartof | Critical care medicine, 2000-10, Vol.28 (10), p.3396-3404 |
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| subjects | Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiotonic Agents - therapeutic use Chronic Disease Dobutamine - therapeutic use Elective Surgical Procedures - adverse effects Elective Surgical Procedures - mortality Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery Hemodynamics - drug effects Humans Intensive care medicine Intraoperative Care - methods Medical sciences Middle Aged Morbidity Multiple Organ Failure - etiology Oxygen Consumption - drug effects Postoperative Care - methods Prospective Studies Survival Analysis Time Factors Treatment Outcome Tropical medicine |
| title | Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients |
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