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Decision support guided fluid challenges and stroke volume response during high-risk surgery: a post hoc analysis of a randomized controlled trial.
J Clin Monit Comput
January 2025
Department of Anaesthesiology and Intensive Care, Bicetre hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicetre, France.
Intravenous fluid is administered during high-risk surgery to optimize stroke volume (SV). To assess ongoing need for fluids, the hemodynamic response to a fluid bolus is evaluated using a fluid challenge technique. The Acumen Assisted Fluid Management (AFM) system is a decision support tool designed to ease the application of fluid challenges and thus improve fluid administration during high-risk surgery.
View Article and Find Full Text PDFEfficacy of Early Goal-Directed Therapy in Septic Shock Management: A Systematic Review.
Cureus
November 2024
Obstetrics and Gynecology, Private Clinic "Yana Alexandr", Sana'a, YEM.
Septic shock is a serious and life-threatening illness marked by potentially fatal and metabolic abnormalities, leading to high mortality rates in adult patients. Early goal-directed therapy (EGDT) was introduced as a systematic approach to manage septic shock through early, protocol-based hemodynamic optimization to improve outcomes. This systematic review aims to evaluate the efficacy of EGDT in managing adult patients with septic shock.
View Article and Find Full Text PDFIntraoperative goal-directed hemodynamic therapy targeting both arterial pressure and flow parameters using uncalibrated pulse contour techniques: A meta-analysis of randomized controlled trials.
Rev Esp Anestesiol Reanim (Engl Ed)
December 2024
Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care, Madrid, Spain; Hospital Universitario Puerto Real, Cádiz, Spain.
Background: Goal-directed haemodynamic therapy (GDHT) aims to optimize haemodynamic variables. However, its effectiveness in reducing postoperative complications in major abdominal surgery, particularly when targeting both arterial pressure and flow variables, remains unclear. This meta-analysis addresses this by evaluating GDHT using uncalibrated pulse contour (uPC) methods.
View Article and Find Full Text PDFSystematic review and meta-analysis of goal-directed haemodynamic therapy algorithms during surgery for the prevention of surgical site infection.
EClinicalMedicine
December 2024
Department of Surgery, Amsterdam UMC, Location the University of Amsterdam, Amsterdam, the Netherlands.
Background: Surgical site infection (SSI) is the most common postoperative complication. Goal-directed haemodynamic therapy (GDHT) may help to prevent SSI, but recommendations for its use initially have been set at conditional because of low-certainty evidence at the time. An updated systematic review with SSI as the primary endpoint has not been performed since 2011, and important new evidence has emerged.
View Article and Find Full Text PDFEarly and concomitant administration of norepinephrine and ilomedin improves microcirculatory perfusion without impairing macrocirculation in an intestinal ischemia-reperfusion injury swine model : a randomized experimental trial.
Shock
December 2024
Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Article Synopsis
- Intestinal ischemia-reperfusion injury can lead to both large-scale (macrocirculatory) and small-scale (microcirculatory) blood flow failures, and the study aimed to test if combining a vasoconstrictor (norepinephrine) with a vasodilator (ilomedin) improves blood pressure and circulation after injury.
- The research was conducted on 21 pigs, with three groups receiving different treatments before and after a 2-hour induced small bowel ischemia followed by reperfusion, measuring various circulatory parameters and biomarkers.
- Results showed no significant differences in mean arterial pressure or cardiac index between the groups, but the combination therapy group had notably better microcirculation performance immediately after and two
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