دورية أكاديمية
أعرض في EDS

Pilot Study to Optimize Goal-directed Hemodynamic Management During Pancreatectomy.

التفاصيل البيبلوغرافية
العنوان: Pilot Study to Optimize Goal-directed Hemodynamic Management During Pancreatectomy.
المؤلفون: Galouzis N; Department of Surgery, University of Arizona, Tucson, Arizona., Khawam M; Department of Surgery, University of Arizona, Tucson, Arizona., Alexander EV; Department of Surgery, University of Arizona, Tucson, Arizona., Khreiss MR; Department of Surgery, University of Arizona, Tucson, Arizona., Luu C; Department of Surgery, University of Arizona, Tucson, Arizona., Mesropyan L; Department of Surgery, University of Arizona, Tucson, Arizona., Riall TS; Department of Surgery, University of Arizona, Tucson, Arizona. Electronic address: tsriall@arizona.edu., Kwass WK; Department of Anesthesia, University of Arizona, Tucson, Arizona., Dull RO; Department of Anesthesia, University of Arizona, Tucson, Arizona.
المصدر: The Journal of surgical research [J Surg Res] 2024 Aug; Vol. 300, pp. 173-182. Date of Electronic Publication: 2024 May 29.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Academic Press Country of Publication: United States NLM ID: 0376340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-8673 (Electronic) Linking ISSN: 00224804 NLM ISO Abbreviation: J Surg Res Subsets: MEDLINE
أسماء مطبوعة: Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
مواضيع طبية MeSH: Pancreatectomy*/adverse effects , Hypotension*/prevention & control , Hypotension*/etiology , Hypotension*/diagnosis , Monitoring, Intraoperative*/methods , Hemodynamics*, Humans ; Pilot Projects ; Middle Aged ; Female ; Male ; Aged ; Intraoperative Complications/prevention & control ; Intraoperative Complications/etiology ; Intraoperative Complications/epidemiology ; Hemodynamic Monitoring/methods ; Adult ; Algorithms ; Fluid Therapy/methods ; Clinical Decision-Making/methods
مستخلص: Introduction: Intraoperative goal-directed hemodynamic therapy (GDHT) is a cornerstone of enhanced recovery protocols. We hypothesized that use of an advanced noninvasive intraoperative hemodynamic monitoring system to guide GDHT may decrease intraoperative hypotension (IOH) and improve perfusion during pancreatic resection.
Methods: The monitor uses machine learning to produce the Hypotension Prediction Index to predict hypotensive episodes. A clinical decision-making algorithm uses the Hypotension Prediction Index and hemodynamic data to guide intraoperative fluid versus pressor management. Pre-implementation (PRE), patients were placed on the monitor and managed per usual. Post-implementation (POST), anesthesia teams were educated on the algorithm and asked to use the GDHT guidelines. Hemodynamic data points were collected every 20 s (8942 PRE and 26,638 POST measurements). We compared IOH (mean arterial pressure <65 mmHg), cardiac index >2, and stroke volume variation <12 between the two groups.
Results: 10 patients were in the PRE and 24 in the POST groups. In the POST group, there were fewer minimally invasive resections (4.2% versus 30.0%, P = 0.07), more pancreaticoduodenectomies (75.0% versus 20.0%, P < 0.01), and longer operative times (329.0 + 108.2 min versus 225.1 + 92.8 min, P = 0.01). After implementation, hemodynamic parameters improved. There was a 33.3% reduction in IOH (5.2% ± 0.1% versus 7.8% ± 0.3%, P < 0.01, a 31.6% increase in cardiac index >2.0 (83.7% + 0.2% versus 63.6% + 0.5%, P < 0.01), and a 37.6% increase in stroke volume variation <12 (73.2% + 0.3% versus 53.2% + 0.5%, P < 0.01).
Conclusions: Advanced intraoperative hemodynamic monitoring to predict IOH combined with a clinical decision-making tree for GDHT may improve intraoperative hemodynamic parameters during pancreatectomy. This warrants further investigation in larger studies.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Goal-directed hemodynamic therapy (GDHT); Intraoperative hypotension; Pancreatectomy; Pancreaticoduodenectomy
تواريخ الأحداث: Date Created: 20240530 Date Completed: 20240714 Latest Revision: 20240714
رمز التحديث: 20240715
DOI: 10.1016/j.jss.2024.04.035
PMID: 38815516
قاعدة البيانات: MEDLINE
الوصف
تدمد:1095-8673
DOI:10.1016/j.jss.2024.04.035