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Optimizing stroke volume and oxygen delivery in elective abdominal aortic surgery

Introduction

Patients undergoing elective abdominal aortic surgery (EAAS) are at risk of developing complications due to preoperative co-morbidity, surgical trauma, blood loss and inflammatory injury [1]. Individualized goal-directed therapy (IGDT) has been proposed to improve outcome in patients undergoing high-risk surgery [2]. The aim of this study was to investigate whether IGDT, targeting stroke volume (SV) and oxygen delivery (DO2), can be performed safely in EAAS.

Methods

Sixty-three EAAS patients were randomized to IGDT or conventional therapy. The LiDCO™plus system was used for SV and DO2 monitoring. SV was optimized by 250 ml fluid challenges intraoperatively and the first 6 hours postoperatively. DO2 was optimized 6 hours postoperatively targeting a DO2I level of 600 ml/min/m2, by infusion of dobutamine, if necessary. Hemodynamic data were collected at baseline (t0) preoperatively (t1), before aortic cross-clamping (t2), at the end of surgery (t3), and the first 6 hours postoperatively (p1 to p6). All patients were monitored with five-lead ECG during dobutamine infusion and dosage was reduced at signs of ischemia or heart rate >20% above baseline. Dobutamine dosage was limited to a maximum of 10 μg/kg/minute.

Results

The mean SVI level was 19.4% higher at p4 to p6 in the IGDT group compared with the control group (P = 0.02), and 12.1% higher in the entire intervention period (t1 to p6) (P = 0.07). The mean DO2I was 18.0% higher at p4 to p6 (P = 0.01) and 12.9% higher in the entire intervention period (t1 to p6) in the IGDT group (P = 0.03). Mean arterial pressure and heart rate did not differ significantly (P = 0.12 and P = 0.21). There was no difference in the frequency of postoperative cardiac complications between the groups.

Conclusions

The results of this study demonstrate that IGDT targeting SV and DO2 can be performed safely in patients undergoing EAAS. Whether this intervention is beneficial is being evaluated in the current study.

References

  1. 1.

    Dardik , et al: Results of elective abdominal aortic aneurism repair in the 1990s: A population-based analysis of 2335 cases. J Vasc Surg. 1999, 30: 985-995. 10.1016/S0741-5214(99)70036-4.

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    Bundgaard-Nielsen , et al: Monitoring of perioperative fluid administration by individualized goal-directed therapy. Acta Anaestesiol Scand. 2007, 51: 331-340. 10.1111/j.1399-6576.2006.01221.x.

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Correspondence to J Bisgaard.

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Bisgaard, J., Rønholm, E., Gilsaa, T. et al. Optimizing stroke volume and oxygen delivery in elective abdominal aortic surgery. Crit Care 14, P120 (2010). https://doi.org/10.1186/cc8352

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Keywords

  • Stroke Volume
  • Dobutamine
  • Conventional Therapy
  • Oxygen Delivery
  • Cardiac Complication