title: Haemodynamic optimisation in lower limb arterial surgery: room for improvement?
abstract: BACKGROUND
  Goal-directed therapy has been proposed to improve outcome in high-risk surgery patients. The aim of this study was to investigate whether individualised goal-directed therapy targeting stroke volume and oxygen delivery could reduce the number of patients with post-operative complications and shorten hospital length of stay after open elective lower limb arterial surgery.
  
  
  METHODS
  Forty patients scheduled for open elective lower limb arterial surgery were prospectively randomised. The LiDCO™plus system was used for haemodynamic monitoring. In the intervention group, stroke volume index was optimised by administering 250 ml aliquots of colloid intraoperatively and during the first 6 h post-operatively. Following surgery, fluid optimisation was supplemented with dobutamine, if necessary, targeting an oxygen delivery index level ≥ 600 ml/min(/) m(2) in the intervention group. Central haemodynamic data were blinded in control patients. Patients were followed up after 30 days.
  
  
  RESULTS
  In the intervention group, stroke volume index, and cardiac index were higher throughout the treatment period (45 ± 10 vs. 41 ± 10 ml/m(2), P < 0.001, and 3.19 ± 0.73 vs. 2.77 ± 0.76 l/min(/) m(2), P < 0.001, respectively) as well as post-operative oxygen delivery index (527 ± 120 vs. 431 ± 130 ml/min(/) m(2), P < 0.001). In the same group, 5/20 patients had one or more complications vs. 11/20 in the control group (P = 0.05). After adjusting for pre-operative and intraoperative differences, the odds ratio for ≥ 1 complications was 0.18 (0.04-0.85) in the intervention group (P = 0.03). The median length of hospital stay did not differ between groups.
  
  
  CONCLUSIONS
  Perioperative individualised goal-directed therapy may reduce post-operative complications in open elective lower limb arterial surgery.
authors.affiliation: Department of Anaesthesia and Intensive Care, Lillebaelt Hospital Kolding, Kolding, Denmark. janniebisgaard@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Bisgaard
authors.forename: T
authors.initials: T
authors.lastname: Gilsaa
authors.forename: E
authors.initials: E
authors.lastname: Rønholm
authors.forename: P
authors.initials: P
authors.lastname: Toft
mesh_terms: D000368:Aged; D001158:Arteries / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D003102:Colloids / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood; D010952:Plasma Substitutes / Q000627:therapeutic use; D057285:Precision Medicine; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D003102:Colloids; D010952:Plasma Substitutes; D010100:Oxygen