tailieunhanh - Báo cáo y học: "Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised controlled trial"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised controlled trial. | Jhanji et al. Critical Care 2010 14 R151 http content 14 4 R151 c CRITICAL CARE RESEARCH Open Access Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery a randomised controlled trial Shaman Jhanji1 Amanda Vivian-Smith2 Susana Lucena-Amaro2 David Watson1 Charles J Hinds1 Rupert M Pearse1 Abstract Introduction Post-operative outcomes may be improved by the use of flow related end-points for intra-venous fluid and or low dose inotropic therapy. The mechanisms underlying this benefit remain uncertain. The objective of this study was to assess the effects of stroke volume guided intra-venous fluid and low dose dopexamine on tissue microvascular flow and oxygenation and inflammatory markers in patients undergoing major gastrointestinal surgery. Methods Randomised controlled single blind study of patients admitted to a university hospital critical care unit following major gastrointestinal surgery. For eight hours after surgery intra-venous fluid therapy was guided by measurements of central venous pressure CVP group or stroke volume SV group . In a third group stroke volume guided fluid therapy was combined with dopexamine mcg kg min SV DPX group . Results 135 patients were recruited n 45 per group . In the SV DPX group increased global oxygen delivery was associated with improved sublingual P and cutaneous microvascular flow P sublingual microscopy and laser Doppler flowmetry . Microvascular flow remained constant in the SV group but deteriorated in the CVP group P . Cutaneous tissue oxygen partial pressure PtO2 Clark electrode improved only in the SV DPX group P . There were no differences in serum inflammatory markers. There were no differences in overall complication rates between the groups although acute kidney injury was more frequent in the CVP group CVP group ten patients 22 pooled SV and SV DPX groups seven patients 8 P post hoc analysis . Conclusions Stroke volume guided .