Does goal-directed fluid therapy affect postoperative orthostatic intolerance?: A randomized trial.

Abstract

BACKGROUND:

Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume-guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial.

METHODS:

Forty-two patients scheduled for open radical prostatectomy were randomized into standard fluid therapy (control group) or GDT groups. Both groups received a fixed-volume crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid, and in addition, the GDT group received colloid to obtain a maximal stroke volume (esophageal Doppler). The primary outcome was the prevalence of OI assessed with a standardized mobilization protocol before and 6 h after surgery. Hemodynamic and hormonal orthostatic responses were evaluated.

RESULTS:

Twelve (57%) versus 15 (71%) patients in the control and GDT groups (P = 0.33), respectively, demonstrated OI after surgery, group difference 14% (CI, -18 to 45%). Patients in the GDT group received more colloid during surgery (1,758 vs. 1,057 ml; P = 0.001) and reached a higher stroke volume (102 vs. 89 ml; P = 0.04). OI patients had an increased length of hospital stay (3 vs. 2 days; P = 0.02) and impaired hemodynamic and norepinephrine responses on mobilization.

CONCLUSION:

GDT did not reduce the prevalence of OI, and patients with OI demonstrated impaired cardiovascular and hormonal responses to mobilization.

• Authors: Morten Bundgaard-Nielsen, Øivind Jans, Rasmus G Müller, André Korshin, Birgitte Ruhnau, Peter Bie, Niels H Secher, Henrik Kehlet
• Journal: Anesthesiology (Anesthesiology) Vol. 119 Issue 4 Pg. 813-23 (Oct 2013) ISSN: 1528-1175 [Electronic] United States
• PMID: 23756453 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Colloids
• Crystalloid Solutions
• Isotonic Solutions

Topics

• Aged
• Colloids (therapeutic use)
• Crystalloid Solutions
• Denmark
• Double-Blind Method
• Early Ambulation (methods)
• Fluid Therapy (methods)
• Goals
• Humans
• Isotonic Solutions (therapeutic use)
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Orthostatic Intolerance (therapy)
• Perioperative Care (methods)
• Postoperative Complications (therapy)
• Prospective Studies
• Prostatectomy (methods)
• Stroke Volume
• Treatment Outcome