Prospective, randomized trial comparing fluids and dobutamine optimization of oxygen delivery in high-risk surgical patients [ISRCTN42445141].
BACKGROUND
Preventing perioperative tissue oxygen debt contributes to a better postoperative recovery. Whether the beneficial effects of fluids and inotropes during optimization of the oxygen delivery index (DO2I) in high-risk patients submitted to major surgeries are due to fluids, to inotropes, or to the combination of the two is not known. We aimed to investigate the effect of DO2I optimization with fluids or with fluids and dobutamine on the 60-day hospital mortality and incidence of complications.


METHODS
A randomized and controlled trial was performed in 50 high-risk patients (elderly with coexistent pathologies) undergoing major elective surgery. Therapy consisted of pulmonary artery catheter-guided hemodynamic optimization during the operation and 24 hours postoperatively using either fluids alone (n = 25) or fluids and dobutamine (n = 25), aiming to achieve supranormal values (DO2I > 600 ml/minute/m2).


RESULTS
The cardiovascular depression was an important component in the perioperative period in this group of patients. Cardiovascular complications in the postoperative period occurred significantly more frequently in the volume group (13/25, 52%) than in the dobutamine group (4/25, 16%) (relative risk, 3.25; 95% confidence interval, 1.22-8.60; P < 0.05). The 60-day mortality rates were 28% in the volume group and 8% in the dobutamine group (relative risk, 3.00; 95% confidence interval, 0.67-13.46; not significant).


CONCLUSIONS
In patients with high risk of perioperative death, pulmonary artery catheter-guided hemodynamic optimization using dobutamine determines better outcomes, whereas fluids alone increase the incidence of postoperative complications.
Lobo
Suzana M
SM
Division of Critical Care Medicine, Department of Internal Medicine, Medical School-FUNFARME and Hospital de Base, São José do Rio Preto, São Paulo, Brazil. suzanalobo@yahoo.com
Lobo
Francisco R
FR
Polachini
Carlos A
CA
Patini
Daniela S
DS
Yamamoto
Adriana E
AE
de Oliveira
Neymar E
NE
Serrano
Patricia
P
Sanches
Helder S
HS
Spegiorin
Marco A
MA
Queiroz
Marcio M
MM
Christiano
Antonio C
AC
Savieiro
Elisangela F
EF
Alvarez
Paula A
PA
Teixeira
Silvia P
SP
Cunrath
Geni S
GS
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002407:Catheterization, Swan-Ganz / Q000379:methods; D004280:Dobutamine / Q000494:pharmacology / Q000627:therapeutic use*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors
D004280:Dobutamine