title: Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients.
abstract: BACKGROUND
  Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV).
  
  
  OBJECTIVE
  We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes.
  
  
  METHODS
  All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors.
  
  
  RESULTS
  Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group.
  
  
  CONCLUSIONS
  Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.|Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kratz
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Simon
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Marburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Fendrich
authors.affiliation: Center for Hereditary Tumors at the Surgical Center, HELIOS Klinikum Wuppertal, University Witten/Herdecke, Wuppertal, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Schneider
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.
authors.forename: Hinnerk
authors.initials: H
authors.lastname: Wulf
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.|Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kratz
authors.affiliation: Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany.
authors.forename: Turgay
authors.initials: T
authors.lastname: Efe
authors.affiliation: Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Schüttler
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany.|Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Kreisklinikum, Siegen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Zoremba
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D055615:Electrical Equipment and Supplies; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data*; D010179:Pancreas / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*
keywords: Goal directed therapy; fluid therapy; major abdominal surgery; pancreatic surgery; pluse-contour-automated-analysis