title: Continuous central venous oxygen saturation assisted intraoperative hemodynamic management during major abdominal surgery: a randomized, controlled trial.
abstract: BACKGROUND
  Major abdominal surgery is associated with significant risk of morbidity and mortality in the perioperative period. Optimising intraoperative fluid administration may result in improved outcomes. Our aim was to compare the effects of central venous pressure (CVP), and central venous oxygen saturation (ScvO2)-assisted fluid therapy on postoperative complications in patients undergoing high risk surgery.
  
  
  METHODS
  Patients undergoing elective major abdominal surgery were randomised into control and ScvO2 groups. The target level of mean arterial pressure (MAP) was ≥ 60 mmHg in both groups. In cases of MAP < 60 mmHg patients received either a fluid or vasopressor bolus according to the CVP < 8 mmHg in the control group. In the ScvO2 group, in addition to the MAP, an ScvO2 of <75% or a >3% decrease indicated need for intervention, regardless of the actual MAP. Data are presented as mean ± standard deviation or median (interquartile range).
  
  
  RESULTS
  We observed a lower number of patients with complications in the ScvO2 group compared to the control group, however it did not reach statistical significance (ScvO2 group: 10 vs.
  
  
  METHODS
  19; p = 0.07). Patients in the ScvO2 group (n = 38) received more colloids compared to the control group (n = 41) [279(161) vs. 107(250) ml/h; p < 0.001]. Both groups received similar amounts of crystalloid (1126 ± 471 vs. 1049 ± 431 ml/h; p = 0.46) and norepinephrine [37(107) vs. 18(73) mcg/h; p = 0.84]. Despite similar blood loss in both groups, the ScvO2 group received more blood transfusions (63% vs. 37%; p = 0.018). More patients in the control group had a postoperative PaO2/FiO2 < 200 mmHg (23 vs. 10, p < 0.01). Twenty eight day survival was significantly higher in the ScvO2 group (37/38 vs. 33/41 p = 0.018).
  
  
  CONCLUSIONS
  ScvO2-assisted intraoperative haemodynamic support provided some benefits, including significantly better postoperative oxygenation and 28 day survival rate, compared to CVP-assisted therapy without a significant effect on postoperative complications during major abdominal surgery.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02337010.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary. andrasmikor@gmail.com.
authors.forename: András
authors.initials: A
authors.lastname: Mikor
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary.
authors.forename: Domonkos
authors.initials: D
authors.lastname: Trásy
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary.
authors.forename: Márton F
authors.initials: MF
authors.lastname: Németh
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary.
authors.forename: Angelika
authors.initials: A
authors.lastname: Osztroluczki
authors.affiliation: Hungarian Defence Forces Medical Center, Budapest, Hungary.
authors.forename: Szilvia
authors.initials: S
authors.lastname: Kocsi
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary.
authors.forename: Ildikó
authors.initials: I
authors.lastname: Kovács
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Demeter
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis str., 6725, Szeged, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Molnár
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011183:Postoperative Complications / Q000453:epidemiology*; D015996:Survival Rate; D014690:Venous Pressure / Q000502:physiology
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010100:Oxygen