Pub Date : 2025-01-01DOI: 10.1016/j.redar.2024.01.009
A.A. Pires , M.J. Correia , J. Sousa
Anaesthesia for kidney transplant in a patient with severe mitral regurgitation is a real challenge given the need for judicious haemodynamic management to avoid pulmonary oedema and maximise reperfusion of the transplanted organ. This is the first experience described in the literature of continuous spinal anaesthesia in a patient with chronic severe mitral regurgitation undergoing cadaver donor kidney transplant. Transthoracic echocardiography monitoring was used during the procedure to avoid aggravating the patient's mitral regurgitation. Intraoperatively, 17.5 ml/kg of crystalloids were administered and no vasopressors were required. Continuous spinal anaesthesia preserved haemodynamics and graft perfusion during the procedure.
{"title":"Anestesia espinal continua para trasplante renal en una paciente de lupus con regurgitación mitral grave: informe de un caso","authors":"A.A. Pires , M.J. Correia , J. Sousa","doi":"10.1016/j.redar.2024.01.009","DOIUrl":"10.1016/j.redar.2024.01.009","url":null,"abstract":"<div><div>Anaesthesia for kidney transplant in a patient with severe mitral regurgitation is a real challenge given the need for judicious haemodynamic management to avoid pulmonary oedema and maximise reperfusion of the transplanted organ. This is the first experience described in the literature of continuous spinal anaesthesia in a patient with chronic severe mitral regurgitation undergoing cadaver donor kidney transplant. Transthoracic echocardiography monitoring was used during the procedure to avoid aggravating the patient's mitral regurgitation. Intraoperatively, 17.5<!--> <!-->ml/kg of crystalloids were administered and no vasopressors were required. Continuous spinal anaesthesia preserved haemodynamics and graft perfusion during the procedure.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 1","pages":"Article 101617"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.redar.2024.03.003
D. Revuelta , M. López-Baamonde , M. Vendrell , A. Plaza , T. Cobo , M. Magaldi
Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure (ICP) of unknown etiology, more prevalent in obese women of childbearing age. The management of IIH during pregnancy represents a multidisciplinary challenge, as medical treatment is contentious due to the fetal teratogenic risk, and the technically challenging placement of a ventriculoperitoneal shunt is hindered by the presence of the pregnant uterus. The goal of anesthetic management during childbirth is to maintain hemodynamic stability, cerebral perfusion pressure, and cerebral tissue oxygenation, while avoiding abrupt fluctuations in intracranial pressure. The choice of anesthetic technique is complex and depends on the assessment of risks and benefits associated with each technique, involving a decision between neuraxial anesthesia and general anesthesia.
We present the case of a pregnant woman with rapidly progressing IIH, approached in a multidisciplinary manner, whose anaesthetic management was technically challenging, resulting in a favourable outcome without subsequent complications.
{"title":"Hipertensión intracraneal idiopática durante la gestación. A propósito de un caso","authors":"D. Revuelta , M. López-Baamonde , M. Vendrell , A. Plaza , T. Cobo , M. Magaldi","doi":"10.1016/j.redar.2024.03.003","DOIUrl":"10.1016/j.redar.2024.03.003","url":null,"abstract":"<div><div>Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure (ICP) of unknown etiology, more prevalent in obese women of childbearing age. The management of IIH during pregnancy represents a multidisciplinary challenge, as medical treatment is contentious due to the fetal teratogenic risk, and the technically challenging placement of a ventriculoperitoneal shunt is hindered by the presence of the pregnant uterus. The goal of anesthetic management during childbirth is to maintain hemodynamic stability, cerebral perfusion pressure, and cerebral tissue oxygenation, while avoiding abrupt fluctuations in intracranial pressure. The choice of anesthetic technique is complex and depends on the assessment of risks and benefits associated with each technique, involving a decision between neuraxial anesthesia and general anesthesia.</div><div>We present the case of a pregnant woman with rapidly progressing IIH, approached in a multidisciplinary manner, whose anaesthetic management was technically challenging, resulting in a favourable outcome without subsequent complications.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 1","pages":"Article 101623"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.redar.2024.05.003
R.M. Sethuraman, S. Krishnakumar, S. Rajendran
{"title":"Comentario sobre: «Bloqueo costoclavicular con inyección única vs doble: ensayo de no inferioridad»","authors":"R.M. Sethuraman, S. Krishnakumar, S. Rajendran","doi":"10.1016/j.redar.2024.05.003","DOIUrl":"10.1016/j.redar.2024.05.003","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 1","pages":"Article 101639"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.redar.2024.03.009
J.R. Seshan, I. Kapoor, H. Prabhakar, C. Mahajan
Introduction and objectives
Anaesthesia during surgery for moyamoya disease (MMD) has different effects on cerebral physiology. Both sevoflurane and propofol have cerebral protective effects, albeit with different mechanisms. We used near infrared spectroscopy (NIRS) to observe the effect of sevoflurane and propofol on rSO2 in paediatric patients undergoing MMD surgery.
Materials and methods
We included paediatric patients ASA grade I aged between 1 and 18 years undergoing surgery for MMD over a period of 1 year (from 1 April 2018 to 1 April 2019). Patients were randomized to 2 groups: Group S (sevoflurane) and Group P (propofol). NIRS values were recorded at 5 time points: T1 (baseline) T2 (after preoxygenation), T3 (after induction), T4 (end of surgery), T5 (after extubation). One-way ANOVA was used for intra-group comparisons and two-way repeated measures ANOVA with Bonferroni correction were used for inter-group comparisons. P value < 0.05 was considered significant.
Results
A total of 20 patients were included in the study. The average age was 10.5 ± 4.3 years. The mean baseline rSO2 was 78.35 ± 10.58 and 77.95 ± 8.81 in the right and left hemispheres, respectively. In both groups, rSO2 values increased between baseline and anaesthesia induction and fell slightly at the end of surgery. The inter-group analysis showed no statistically significant change between rSO2 values.
Conclusion
Both sevoflurane and propofol maintain adequate rSO2 levels in children undergoing surgery for MMD.
Clinical trial registration number: CTRI/2018/04/013229 registered on 12.04.2018.
{"title":"Efecto de propofol frente a sevoflurano en la oxigenación cerebral en la enfermedad de Moyamoya pediátrica. Estudio de espectroscopia de infrarrojo cercano","authors":"J.R. Seshan, I. Kapoor, H. Prabhakar, C. Mahajan","doi":"10.1016/j.redar.2024.03.009","DOIUrl":"10.1016/j.redar.2024.03.009","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Anaesthesia during surgery for moyamoya disease (MMD) has different effects on cerebral physiology. Both sevoflurane and propofol have cerebral protective effects, albeit with different mechanisms. We used near infrared spectroscopy (NIRS) to observe the effect of sevoflurane and propofol on rSO<sub>2</sub> in paediatric patients undergoing MMD surgery.</div></div><div><h3>Materials and methods</h3><div>We included paediatric patients ASA grade I aged between 1 and 18 years undergoing surgery for MMD over a period of 1 year (from 1 April 2018 to 1 April 2019). Patients were randomized to 2 groups: Group S (sevoflurane) and Group P (propofol). NIRS values were recorded at 5 time points: T1 (baseline) T2 (after preoxygenation), T3 (after induction), T4 (end of surgery), T5 (after extubation). One-way ANOVA was used for intra-group comparisons and two-way repeated measures ANOVA with Bonferroni correction were used for inter-group comparisons. <em>P</em> value <<!--> <!-->0.05 was considered significant.</div></div><div><h3>Results</h3><div>A total of 20 patients were included in the study. The average age was 10.5<!--> <!-->±<!--> <!-->4.3 years. The mean baseline rSO<sub>2</sub> was 78.35<!--> <!-->±<!--> <!-->10.58 and 77.95<!--> <!-->±<!--> <!-->8.81 in the right and left hemispheres, respectively. In both groups, rSO<sub>2</sub> values increased between baseline and anaesthesia induction and fell slightly at the end of surgery. The inter-group analysis showed no statistically significant change between rSO<sub>2</sub> values.</div></div><div><h3>Conclusion</h3><div>Both sevoflurane and propofol maintain adequate rSO<sub>2</sub> levels in children undergoing surgery for MMD.</div><div>Clinical trial registration number: CTRI/2018/04/013229 registered on 12.04.2018.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"72 1","pages":"Article 101630"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141411538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.redar.2024.01.002
D. Díaz Díaz , C. Olmos Mata , E. Palencia Herrejón , L. López Pérez
Eosinophilia in not an uncommon finding in the intensive care unit (ICU); however, DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, which is characterized by a hypersensitivity reaction to drugs and manifests as eosinophilia, systemic involvement and maculopapular erythematous rash 2-6 weeks after exposure to the offending drug, is an exceptional occurrence. We present the first case described in the literature of DRESS syndrome with pulmonary involvement in the form of interstitial pneumonitis and persistent adult respiratory distress syndrome (ARDS) secondary to proton pump inhibitors (PPI). The patient made a good recovery after withdrawal of the offending drug and long-term treatment with systemic corticosteroids.
We also present a systematic review of all cases of DRESS with pulmonary involvement in the form of interstitial pneumonitis and cases of PPI-induced DRESS published to date; none of these describe pulmonary involvement.
{"title":"Síndrome de distrés respiratorio del adulto (SDRA) por reacción farmacológica con eosinofilia y síntomas sistémicos (DRESS) secundario a omeprazol: caso clínico y revisión de la literatura","authors":"D. Díaz Díaz , C. Olmos Mata , E. Palencia Herrejón , L. López Pérez","doi":"10.1016/j.redar.2024.01.002","DOIUrl":"10.1016/j.redar.2024.01.002","url":null,"abstract":"<div><div>Eosinophilia in not an uncommon finding in the intensive care unit (ICU); however, DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, which is characterized by a hypersensitivity reaction to drugs and manifests as eosinophilia, systemic involvement and maculopapular erythematous rash 2-6 weeks after exposure to the offending drug, is an exceptional occurrence. We present the first case described in the literature of DRESS syndrome with pulmonary involvement in the form of interstitial pneumonitis and persistent adult respiratory distress syndrome (ARDS) secondary to proton pump inhibitors (PPI). The patient made a good recovery after withdrawal of the offending drug and long-term treatment with systemic corticosteroids.</div><div>We also present a systematic review of all cases of DRESS with pulmonary involvement in the form of interstitial pneumonitis and cases of PPI-induced DRESS published to date; none of these describe pulmonary involvement.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 763-770"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.redar.2023.04.007
I. Cheong
{"title":"Excursión diafragmática con imagen Doppler tisular en modo M color","authors":"I. Cheong","doi":"10.1016/j.redar.2023.04.007","DOIUrl":"10.1016/j.redar.2023.04.007","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Page 771"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.redar.2024.04.001
J. Ripollés-Melchor , M.I. Monge García , A. Ruiz-Escobar , E. Sáez-Ruiz , B. Algar-Yañez , A. Abad-Motos , A. Abad-Gurumeta
Background
This study aimed to assess the efficacy of estimated preoperative aortic pulse wave velocity (AoPWV) to discriminate between low and high 6 min walk test (6MWT) distance in patients awaiting major non-cardiac surgery.
Methods
Prospective observational study in 133 patients ungergoing non cardiac surgery. AoPWV and the distance walked during a 6MWT were assessed. Receiver operating characteristic (ROC) curve analysis was used to determine two different AoPWV cut-points for predicting a distance of 427 m in the 6MWT. We also calculated lower and upper AoPWV cut-points (probability ≥ 0.75) for predicting a distance of < 427 m, ≥ 427 m, and also 563 m in the 6MWT.
Results
The ROC curve analysis for the < 427 m distance revealed an area under the curve (AUC) of 0.68 (95% confidence interval: 0.56–-0.79) and an AUC of 0.72 (95% confidence interval: 0.61-0.83) for > 563 m. Patients with AoPWV > 10.97 m/s should be considered higher risk, while those with < 9.42 m/s can be considered low risk.
Conclusions
AoPWV is a simple, non-invasive, useful clinical tool for identifying and stratifying patients awaiting major non-cardiac surgery. In situations of clinical uncertainty, additional measures should be taken to assess the risk.
{"title":"Validez de la velocidad estimada de onda de pulso aórtica medida durante la prueba de caminata de 6 minutos para predecir la capacidad anaeróbica antes de la cirugía mayor no cardiaca","authors":"J. Ripollés-Melchor , M.I. Monge García , A. Ruiz-Escobar , E. Sáez-Ruiz , B. Algar-Yañez , A. Abad-Motos , A. Abad-Gurumeta","doi":"10.1016/j.redar.2024.04.001","DOIUrl":"10.1016/j.redar.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess the efficacy of estimated preoperative aortic pulse wave velocity (AoPWV) to discriminate between low and high 6<!--> <!-->min walk test (6MWT) distance in patients awaiting major non-cardiac surgery.</div></div><div><h3>Methods</h3><div>Prospective observational study in 133 patients ungergoing non cardiac surgery. AoPWV and the distance walked during a 6MWT were assessed. Receiver operating characteristic (ROC) curve analysis was used to determine two different AoPWV cut-points for predicting a distance of 427 m in the 6MWT. We also calculated lower and upper AoPWV cut-points (probability ≥<!--> <!-->0.75) for predicting a distance of <<!--> <!-->427<!--> <!-->m, ≥<!--> <!-->427<!--> <!-->m, and also 563<!--> <!-->m in the 6MWT.</div></div><div><h3>Results</h3><div>The ROC curve analysis for the <<!--> <!-->427<!--> <!-->m distance revealed an area under the curve (AUC) of 0.68 (95% confidence interval: 0.56–-0.79) and an AUC of 0.72 (95% confidence interval: 0.61-0.83) for ><!--> <!-->563<!--> <!-->m. Patients with AoPWV ><!--> <!-->10.97<!--> <!-->m/s should be considered higher risk, while those with <<!--> <!-->9.42<!--> <!-->m/s can be considered low risk.</div></div><div><h3>Conclusions</h3><div>AoPWV is a simple, non-invasive, useful clinical tool for identifying and stratifying patients awaiting major non-cardiac surgery. In situations of clinical uncertainty, additional measures should be taken to assess the risk.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 710-718"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.redar.2024.04.003
M.J. Colomina , P. Galán Menéndez , J. Ripollés-Melchor
The administration of intravenous fluids is the most common intervention in hospitalized patients in the perioperative setting and critical care units. The aim of this narrative review is to provide an overview of balanced solutions in fluid therapy in the perioperative period in adult patients, and to review new trends and solutions in fluid therapy.
The evidence was grouped into 3 areas: intraoperative fluid administration, fluid administration in the critically ill patient and the relevance / benefit of balanced crystalloid solutions.
Although in recent years there has been an improvement in high-quality published studies, the scientific evidence regarding choice of fluid, dose and rate of administration is still limited. The choice of fluid therapy during the perioperative period must be individualized, considering patient-specific factors, the nature of the surgery, expected fluid loss and other relevant factors. Finally, more robust clinical evidence and training of clinicians should be of utter importance.
{"title":"Uso de fluidoterapia en el periodo perioperatorio en pacientes adultos: revisión narrativa","authors":"M.J. Colomina , P. Galán Menéndez , J. Ripollés-Melchor","doi":"10.1016/j.redar.2024.04.003","DOIUrl":"10.1016/j.redar.2024.04.003","url":null,"abstract":"<div><div>The administration of intravenous fluids is the most common intervention in hospitalized patients in the perioperative setting and critical care units. The aim of this narrative review is to provide an overview of balanced solutions in fluid therapy in the perioperative period in adult patients, and to review new trends and solutions in fluid therapy.</div><div>The evidence was grouped into 3 areas: intraoperative fluid administration, fluid administration in the critically ill patient and the relevance / benefit of balanced crystalloid solutions.</div><div>Although in recent years there has been an improvement in high-quality published studies, the scientific evidence regarding choice of fluid, dose and rate of administration is still limited. The choice of fluid therapy during the perioperative period must be individualized, considering patient-specific factors, the nature of the surgery, expected fluid loss and other relevant factors. Finally, more robust clinical evidence and training of clinicians should be of utter importance.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 748-759"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.redar.2023.07.008
R. Eizaga Rebollar , A. Alonso Ojembarrena
{"title":"Quiste filar en ecografía previa a raquianestesia neonatal","authors":"R. Eizaga Rebollar , A. Alonso Ojembarrena","doi":"10.1016/j.redar.2023.07.008","DOIUrl":"10.1016/j.redar.2023.07.008","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Page 762"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.redar.2024.04.004
J. Ripollés-Melchor , Á.V. Espinosa , P. Fernández-Valdes-Bango , R. Navarro-Pérez , A. Abad-Motos , J.V. Lorente , M.J. Colomina , E. Sáez-Ruiz , A. Abad-Gurumeta , M.I. Monge-García
Objective
To evaluate the clinical impact of optimizing stroke volume (SV) through fluid administration as part of goal-directed hemodynamic therapy (GDHT) in adult patients undergoing elective major abdominal surgery.
Methods
This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO database in January 2024. The intervention was defined as intraoperative GDHT based on the optimization or maximization of SV through fluid challenges, or by using dynamic indices of fluid responsiveness, including stroke volume variation, pulse pressure variation, and plethysmography variation index compared to usual fluid management. The primary outcome was postoperative complications. Secondary outcome variables included postoperative acute kidney injury (AKI), length of stay (LOS), intraoperative fluid administration, and 30-day mortality.
Results
A total of 29 randomized controlled trials (RCTs) met the inclusion criteria. There were no significant differences in the incidence of postoperative complications (RR 0.89; 95% CI, 0.78 to 1.00), postoperative AKI (OR 0.97; (95% IC, 0.55 to 1.70), and mortality (OR 0.80; 95% CI, 0.50 to 1.29). GDHT was associated with a reduced LOS compared to usual care (SMD: −0.17 [−0.32; - 0.03]). The subgroup in which hydroxyethyl starch was used for hemodynamic optimization was associated with fewer complications (RR 0.79; 95% CI, 0.65 to 0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04 to 1.12).
Conclusions
In adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.
{"title":"Terapia hemodinámica guiada por objetivos mediante la administración de líquidos para optimizar el volumen sistólico: metaanálisis de ensayos controlados aleatorizados","authors":"J. Ripollés-Melchor , Á.V. Espinosa , P. Fernández-Valdes-Bango , R. Navarro-Pérez , A. Abad-Motos , J.V. Lorente , M.J. Colomina , E. Sáez-Ruiz , A. Abad-Gurumeta , M.I. Monge-García","doi":"10.1016/j.redar.2024.04.004","DOIUrl":"10.1016/j.redar.2024.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical impact of optimizing stroke volume (SV) through fluid administration as part of goal-directed hemodynamic therapy (GDHT) in adult patients undergoing elective major abdominal surgery.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO database in January 2024. The intervention was defined as intraoperative GDHT based on the optimization or maximization of SV through fluid challenges, or by using dynamic indices of fluid responsiveness, including stroke volume variation, pulse pressure variation, and plethysmography variation index compared to usual fluid management. The primary outcome was postoperative complications. Secondary outcome variables included postoperative acute kidney injury (AKI), length of stay (LOS), intraoperative fluid administration, and 30-day mortality.</div></div><div><h3>Results</h3><div>A total of 29 randomized controlled trials (RCTs) met the inclusion criteria. There were no significant differences in the incidence of postoperative complications (RR 0.89; 95% CI, 0.78 to 1.00), postoperative AKI (OR 0.97; (95% IC, 0.55 to 1.70), and mortality (OR 0.80; 95% CI, 0.50 to 1.29). GDHT was associated with a reduced LOS compared to usual care (SMD: −0.17 [−0.32; - 0.03]). The subgroup in which hydroxyethyl starch was used for hemodynamic optimization was associated with fewer complications (RR 0.79; 95% CI, 0.65 to 0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04 to 1.12).</div></div><div><h3>Conclusions</h3><div>In adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 719-731"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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