• Eur J Anaesthesiol · Feb 2019

    Randomized Controlled Trial Multicenter Study

    Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial.

    • Hans Bahlmann, Ingvar Halldestam, and Lena Nilsson.
    • From the Department of Medical and Health Sciences and Department of Anaesthesiology and Intensive Care (HB, LN), and the Department of Clinical and Experimental Medicine and Department of Surgery, Linköping University, University Hospital, Linköping, Sweden (IH).
    • Eur J Anaesthesiol. 2019 Feb 1; 36 (2): 153-161.

    BackgroundGoal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications.ObjectivesThe aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care.DesignA randomised controlled study.SettingTwo Swedish university hospitals, between October 2011 and October 2015.PatientsSixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency.InterventionA three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min m and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg.Main Outcome MeasureThe incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list.ResultsFifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P < 0.01) and dobutamine more frequently (27/30 vs. 9/29, P < 0.01). The median [interquartile range, IQR] incidence of complications per patient 5 days after surgery was 2 [0 to 3] in the intervention group and 1 [0 to 2] in the control group (P = 0.10), and after 30 days 4 [2 to 6] in the intervention group and 2 [1 to 4] in the control group (P = 0.10).ConclusionGoal-directed therapy during oesophageal resection did not result in a reduction of the incidence of postoperative complications.Trial RegistrationClinicaltrials.gov identifier: NCT01416077.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…