Practical impact of a decision support for goal-directed fluid therapy on protocol adherence: a clinical implementation study in patients undergoing major abdominal surgery

Journal of Clinical Monitoring and Computing
Alexandre JoostenJoseph Rinehart

Abstract

The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%. We hypothesised that patients in the AFM group would have more time during surgery with a SVV < 13% compared to the control group. All patients had a radial arterial line connected to a pulse contour analysis monitor and received a 2 ml/kg/h maintenance crystalloid infusion. Additional 250 ml crystalloid boluses were administered whenever measured SVV ≥ 13% in the control group, and when the software suggested a fluid bolus in the AFM group. We compared 46 AFM-guided patients to 38 controls. Patients in the AFM group spent significantly more time during surgery with a SVV < 13% compared to the control group (median 92% [82, 96] vs. 76% [54, 86]; P < 0.0005), and received less fluid overall (1775 ml [1225, 2425] vs. 2350 ml [1825, ...Continue Reading

Associated Clinical Trials

References

May 27, 2011·Anesthesia and Analgesia·Timothy E MillerTong J Gan
Aug 17, 2011·Critical Care : the Official Journal of the Critical Care Forum·Maxime CannessonAzriel Perel
Nov 25, 2011·Critical Care : the Official Journal of the Critical Care Forum·Joseph RinehartMaxime Cannesson
Jul 10, 2013·Anesthesia and Analgesia·Joseph RinehartGuy Dumont
Oct 29, 2014·Critical Care : the Official Journal of the Critical Care Forum·Jan BenesFrederic Michard
Mar 7, 2015·Revista española de anestesiología y reanimación·A JoostenM Cannesson
Apr 19, 2015·Critical Care : the Official Journal of the Critical Care Forum·Joseph RinehartMaxime Cannesson

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Citations

Apr 15, 2020·Anesthesia and Analgesia·Cédrick ZaouterThomas M Hemmerling
Sep 27, 2019·Journal of Anesthesia·Sean CoeckelenberghAlexandre Joosten
Mar 15, 2020·Journal of Clinical Monitoring and Computing·Bernd SaugelThomas W L Scheeren
Aug 21, 2020·BMC Anesthesiology·Alexandre JoostenPhilippe Van der Linden
Sep 12, 2019·Journal of Clinical Monitoring and Computing·Frederic MichardBernd Saugel
May 22, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Joseph RinehartAlexandre Joosten
Oct 5, 2019·Best Practice & Research. Clinical Anaesthesiology·Brenton AlexanderAlexandre Joosten
Apr 27, 2021·Anesthesiology·Kamal MaheshwariUNKNOWN Assisted Fluid Management Study Team

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