Oxygen delivery index during goal-directed therapy predicts complications and hospital length of stay in patients undergoing high-risk surgery

Introduction

The aim of this study was to evaluate the efficacy of a goal-directed therapy (GDT) protocol designed to augment the oxygen delivery index (DO₂I) and to assess the relationship between DO₂I measurements and postoperative complications and length of stay.

Methods

A single-centre retrospective cohort study assessing the data obtained during an 8-hour post-operative GDT protocol in consecutive major surgical patients admitted to the ICU.

Results

Thirty-seven patients were included. The median DO₂I increased over the 8-hour protocol from a baseline level of 407 ml/minute/m² to a maximum of 537 ml/minute/m² (P < 0.0001) (Figure 1). Twenty-one (57%) patients developed a postoperative complication. Patients who developed zero or one complication had a higher maximum oxygen delivery index DO₂I than patients who had more than one complication (602 vs. 477 ml/minute/m², P = 0.018) (Table 1). The proportion of patients with a length of stay greater than 2 weeks was less in patients who achieved a DO₂I of at least 600 ml/minute/m² (P = 0.035).

Figure 1

Increase in DO ₂ I from baseline to maximum over the 8-hour protocol.

Table 1 Postoperative complications by achievement of an oxygen delivery index of 600

Conclusion

Postoperative GDT was able to increase DO₂I in the postoperative period. Patients who achieved a DO₂I of 600 ml/minute/m² were less likely to suffer postoperative complications and have a significantly reduced length of hospital stay.