title: Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement.
abstract: BACKGROUND
  The use of goal directed fluid protocols in intermediate risk patients undergoing hip or knee replacement was studied in few trials using invasive monitoring. For this reason we have implemented two different fluid management protocols, both based on a novel totally non-invasive arterial pressure monitoring device and compared them to the standard (no-protocol) treatment applied before the transition in our academic institution.
  
  
  METHODS
  Three treatment groups were compared in this prospective study: the observational (CONTROL, N = 40) group before adoption of fluid protocols and two randomized groups after the transition to protocol fluid management with the use of the continuous non-invasive blood pressure monitoring (CNAP®) device. In the PRESSURE group (N = 40) standard variables were used for restrictive fluid therapy. Goal directed fluid therapy using pulse pressure variation was used in the GDFT arm (N = 40). The influence on the rate of postoperative complications, on the hospital length of stay and other parameters was assessed.
  
  
  RESULTS
  Both protocols were associated with decreased fluid administration and maintained hemodynamic stability. Reduced rate of postoperative infection and organ complications (22 (55 %) vs. 33 (83 %) patients; p = 0.016; relative risk 0.67 (0.49-0.91)) was observed in the GDFT group compared to CONTROL. Lower number of patients receiving transfusion (4 (10 %) in GDFT vs. 17 (43 %) in CONTROL; p = 0.005) might contribute to this observation. No significant differences were observed in other end-points.
  
  
  CONCLUSIONS
  In our study, the use of the fluid protocol based on pulse pressure variation assessed using continuous non-invasive arterial pressure measurement seems to be associated with a reduction in postoperative complications and transfusion needs as compared to standard no-protocol treatment.
  
  
  BACKGROUND
  ACTRN12612001014842.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic. benesj@fnplzen.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Benes
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Haidingerova
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Pouska
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Stepanik
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Stenglova
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Zatloukal
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Richard
authors.initials: R
authors.lastname: Pradl
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Chytra
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, alej Svobody 80, 306 40, Plzen, Czech Republic.
authors.forename: Eduard
authors.initials: E
authors.lastname: Kasal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062186:Arterial Pressure / Q000502:physiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D005440:Fluid Therapy / Q000379:methods; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies