Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial.
BACKGROUND
Our aim was to determine whether substitution of goal-directed fluid therapy (GDT) (perioperative fluid administration) for traditional therapy to manage elderly patients with coronary heart disease scheduled for gastrointestinal (GI) surgery was advantageous. We determined if it would reduce cardiac complications and shorten time to recovery and discharge.


METHODS
Altogether, 60 of these elderly patients were randomized into GDT (n = 30) and control (n = 30) groups. In the GDT group, fluid management was carried out under guidance of hemodynamic status indicators. Types and quantities of fluids administered, blood loss, intraoperative urine output, time of extubation, intensive care unit (ICU) stay, hospital stay, postoperative adverse cardiac events, and GI complications were recorded.


RESULTS
Total fluids infused were 2,910 ± 645 ml (GDT group) and 3,640 ± 771 ml (control group) (p < 0.05). Numbers of adverse cardiac events in the two groups were not significantly different (p = 0.121). Return of GI function was significantly faster in the GDT group (p < 0.001). Median ICU stay was 32.5 h in the GDT group and 47.5 h in the control group (p < 0.001). Median hospital stay was 18 days in the GDT group and 22 days in the control group (p < 0.001).


CONCLUSIONS
GDT was associated with shorter ICU stay and time to discharge and faster return of GI function compared to traditional fluid therapy. The number of adverse cardiac events was similar in the two groups.
Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Li yu Shan Street, Urumqi, 830054, Xinjiang, China, xjzhenghong@aliyun.com.
Hong
H
Zheng
Hai
H
Guo
Jian-Rong
JR
Ye
Lin
L
Chen
Hai-Ping
HP
Ma
D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000150:complications*; D017558:Elective Surgical Procedures; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D020127:Recovery of Function; D016037:Single-Blind Method; D016896:Treatment Outcome