title: Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study.
abstract: BACKGROUND
  Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).
  
  
  METHODS
  160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.
  
  
  RESULTS
  The total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).
  
  
  CONCLUSIONS
  This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.
  
  
  BACKGROUND
  ClinicalTrial.gov, NCT01401283.
authors.forename: Cornelie
authors.initials: C
authors.lastname: Salzwedel
authors.forename: Jaume
authors.initials: J
authors.lastname: Puig
authors.forename: Arne
authors.initials: A
authors.lastname: Carstens
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Molnar
authors.forename: Krisztian
authors.initials: K
authors.lastname: Kiss
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Hussain
authors.forename: Javier
authors.initials: J
authors.lastname: Belda
authors.forename: Mikhail Y
authors.initials: MY
authors.lastname: Kirov
authors.forename: Samir G
authors.initials: SG
authors.lastname: Sakka
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010347:Patient Care Planning; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D017534:Radial Artery / Q000502:physiology