Table 2 Goal-directed therapy strategies and renal outcome measures in studies
Study | Goal | Timing of intervention | GDT monitor | Intervention | Renal outcome | Significantly larger fluid in GDT |
|---|---|---|---|---|---|---|
Studies of GDT in surgery | ||||||
Challand and colleagues [25] | SV optimisation | Intraoperative | Oesophageal Doppler | SV-guided 200 ml HES 6% boluses | Creatinine increase to >149% of baseline during first postoperative week | Yes |
Cecconi and colleagues [24] | Maximise SV and DO2I >600 ml/min/m2 | Intraoperative and 1-hour postoperative | FloTrac/Vigileo | SV-guided HES6% boluses ± dobutamine | Oliguria or AKI | Yes |
Mayer and colleagues [35] | CI >2.5 l/min/m2, SV variation <12% | Intraoperative | FloTrac/Vigileo | 250 to 500 ml colloid boluses ± dobutamine | UO <500 ml/day or required dialysis for acute renal failure | No |
Jhanji and colleagues [31] | SV optimisation | For 8 hours postoperative | Lidco | Gelatin 250 ml to optimise SV ± dopexamine 0.5 μg/kg/min | AKIN criteria AKI | No |
Forget and colleagues [28] | Pulse oximeter plethysmogram variability index <13% | Intraoperative | Pulse oximeter | 250 ml colloid boluses | Postoperative oliguria or RRT | No |
Benes and colleagues [21] | SV variation <10%, CI >2.5 l/min/m2 | Intraoperative | FloTrac/Vigileo | 3 ml/kg colloid boluses ± dobutamine | AKI by POSSUM scoring (increase in blood urea >5 mmol/l from preoperative levels) or RRT | No |
Harten and colleagues [30] | Pulse pressure variation <10% | Intraoperative | Lidco | Boluses of 250 ml of 6% HES if pulse pressure variation >10% | UO <500 ml/day or increase in SCr >30% from the preoperative level | Yes |
Kapoor and colleagues [32] | CVP >6 mmHg, SVV <10%, CI 2.5 to 4.2 l/min/m2, ScvO2 >70% | For 8 hours postoperative | FloTrac and ScvO2 | Colloid boluses inotropes and blood per protocol | Increase in SCr >150 μmol/l, UO <750 ml/24 hours | Noa |
Donati and colleagues [27] | O2 ER <27% | Intraoperative to 24 hours | CVC, arterial line | Colloid boluses ± dobutamine | SCr >2 mg/dl or need for RRT | No |
Lopes and colleagues [34] | Pulse pressure variation <10% | Intraoperative | Arterial line | Colloid boluses 6% HES | UO <500 ml/day or serum creatinine >170 μmol/l or dialysis for AKI | Yes |
Chytra and colleagues [26] | SV optimisation with FTc 0.35 to 0.4 seconds | 12 hours postoperative | Oesophageal Doppler | Colloid boluses 250 ml gelatin or 6% HES | Need for RRT | Yes |
Wakeling and colleagues [42] | SV optimisation | Intraoperative | Oesophageal Doppler | Gelatin colloid boluses | UO <500 ml/day or increase in SCr >30% from the preoperative level | Yes |
Noblett and colleagues [37] | SV optimisation with FTc 0.35 to 0.4 seconds | Intraoperative | Oesophageal Doppler | 6% HES boluses 7 or 3 ml/kg | Increase in SCr or need for RRT | No |
Pearse and colleagues [38] | Optimise SV and DO2I >600 ml/min/m2 | Postoperative 8 hours | Lidco | Gelatin boluses to optimise SV ± dopexamine | Need for RRT | Yes |
McKendry and colleagues [36] | Stroke index >35 ml/m2 | Postoperative 4 hours | Oesophageal Doppler | 200 ml boluses blood or colloid | Need for RRT | Yes |
Gan and colleagues [29] | SV optimisation with FTc 0.35 to 0.4 seconds | Intraoperative | Oesophageal Doppler | 200 ml boluses of 6% HES | UO <500 ml/day or increase in SCr >30% from the preoperative level | Yes |
Bonazzi and colleagues [23] | Cl>3.0/min/m2, PAOP 10 to 18 mmHg, SVR<1,450 dyne ×second/cm5, DO2I >600 ml/min/m2 | Preoperative to 2 days postoperative | Pulmonary artery catheter | Fluid, blood, dobutamine | Oliguria requiring high-dose frusemide or RRT | Yes |
Venn and colleagues [41] | Two GDT groups: CVP >14 mmHg or SV optimisation with FTc >0.35 seconds | Intraoperative | CVC or oesophageal Doppler | Gelatin boluses 100 to 200 ml | UO <500 ml/day or increase in SCr >30% from the preoperative level | Yes |
Lobo and colleagues [33] | DO2I >600 ml/min/m2 | Intraoperative to24 hours | Pulmonary artery catheter | Fluids, blood, inotropes | SCr >3.5 mg/dl or UO <500 ml/24 hours | No |
Pölönen and colleagues [39] | ScvO2 >70% lactate <2 mM | 8 hours postoperative | Pulmonary artery catheter | Fluids, blood, inotropes | Increase in SCr >1.7 mg/dl, UO <750 ml/24 hours | Noa |
Wilson and colleagues [43] | DO2I >600 ml/min/m2, PAOP >12 mmHg | Preoperative to 12 to 24 hours postoperative | Pulmonary artery catheter | Fluids, blood dopexamine or adrenaline | UO <0.5 ml/kg/hour for >3 hours or 50% rise in SCr | No |
Valentine and colleagues [40] | CI >2.8 l/min/m2, PAOP 8 to 15 mmHg, SVR <1,100 dyne × second/cm5 | >14 hours preoperative | Pulmonary artery catheter | Fluids, dobutamine, vasodilators | Need for RRT or oliguria >24 hours with doubling of SCr | Yes |
Bender and colleagues [20] | CI >2.8, PAOP 8 to 14 mmHg, SVR <1,100 dyne × second/cm5 | Preoperative to 16 hours postoperative | Pulmonary artery catheter | Fluids, blood, dopamine, vasodilators | Increase in SCr >1 mg/dl | Yes |
Bishop and colleagues [22] | CI >4.5 l/min/m2, DO2I >760 ml/min/m2, VO2I >166 ml/min/m2 | Attain goal within 24 hours of admission and maintain for48 hours | Pulmonary artery catheter | Fluids, blood, dobutamine, vasodilators | SCr >2 mg/dl or twice baseline in CKD | Yes |
Studies using GDT in surgery comparing restrictive vs. conservative maintenance fluids | ||||||
Lobo and colleagues [46] | DO2I >600 ml/min/m2 | Intraoperative and 8 hours postoperative | Lidco | SV-guided gelatin bolus ± dobutamine in both groups. Maintenance fluid 4 vs. 12 ml/kg/hour | SCr ×2 upper limit of normal | Yes |
Futier and colleagues [44] | Variation in peak aortic flow velocity (ΔPV) <13% | Intraoperative | Oesophageal Doppler | ΔPV-guided boluses of 6% HES in both groups. Maintenance crystalloid 6 vs. 12 ml/kg/hour | UO <500 ml/day or increase in SCr >30% from the preoperative level or need for acute RRT | Yes |
Jammer and colleagues [45] | ScVO2 >75% | Intraoperative | CVC | Colloid boluses 3 ml/kg HES in GDT group. Maintenance fluid 100 ml/hour in GDT vs. 800 ml/hour in controls | SCr increase >33% | Yes |