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2018, Número 2

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Rev Mex Anest 2018; 41 (2)


Terapia de líquidos dirigida por metas en cirugía mayor no cardíaca: metaanálisis y revisión de la literatura

Lagarda-Cuevas J, Juárez-Pichardo JS, Hernández-Pérez AL, Elizalde-López J, Bermúdez-Ochoa G, Sosa-Jaime NA, Yerves-González L, Ruiz Díaz-De León J, Santiago-Sampe NA, Ramírez-Celis JC, Aspuru-García E, Rodríguez-Zepeda JM, Esteban-Aguilar J

Idioma: Español
Referencias bibliográficas: 56
Paginas: 105-116
Archivo PDF: 268.16 Kb.


RESUMEN

Objetivos: Comparar los efectos de la terapia de líquidos dirigidos por objetivos frente a la terapia estándar de manejo de líquidos durante la cirugía electiva mayor no cardíaca, midiendo morbilidad y mortalidad postoperatoria. Material y métodos: Se realizó un metaanálisis de ensayos clínicos controlados de pacientes adultos sometidos a cirugía electiva mayor no cardíaca comparando TLDM versus TEML. Los resultados medidos en el período postoperatorio fueron riesgos relativos para morbilidad y mortalidad. Resultados: Se incluyeron 14 estudios con 1,924 pacientes, de los cuales 961 fueron tratados con TLDM y 963 con TEML. El TLDM se administró en los estudios utilizando varios monitores hemodinámicos invasivos (ecocardiograma transesofágico, línea arterial, catéter venoso central, etc.). El TLDM redujo significativamente la morbilidad del paciente (RR 0.798, IC del 95%: 0.694-0.918, p = 0.002). Las complicaciones incluidas en el análisis fueron: fuga de anastomosis, íleo postoperatorio, dehiscencia e infección de herida quirúrgica. Sin embargo, no hubo diferencias significativas en la mortalidad entre ambos tipos de terapias (RR 0.784, IC del 95%: 0.461-1.335, p = 0.370). Las causas más comunes de mortalidad se debieron a complicaciones cardiovasculares mayores (IAM, arritmias, etc.). Conclusiones: La terapia de líquidos dirigida por objetivos (TLDM) parece beneficiar a pacientes sometidos a cirugía electiva mayor no cardíaca en la reducción de la morbilidad postoperatoria.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Casanova CR, García PJ, Lomillos RV, Aguilera CL. Fluidoterapia perioperatoria. Rev Esp Anestesiol Reanim. 2010;57:575-585.

  2. Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol. 2006;20:265-283.

  3. Navarro LH, Bloomstone JA, Auler JO Jr., Cannesson M, Rocca GD, Gan TJ, et al. Perioperative fluid therapy statement from the international fluid optimization group. Perioper Med (Lond). 2015;4:3.

  4. Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, et al. Effect of perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery. A randomized clinical trial and systematic review. JAMA. 2014;311:2181-2190.

  5. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;55:342-348.

  6. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999;90:896-905.

  7. Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation. Dis Colon Rectum. 2004;47:1397-1402.

  8. Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR. Postoperative fluid overload: not a benign problem. Crit Care Med. 1990;18:728-733.

  9. Slinger PD. Perioperative fluid management for thoracic surgery: the puzzle of postpneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth. 1995;9:442-451.

  10. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723-740.

  11. Woods MS, Kelley H. Oncotic pressure, albumin and ileus: the effect of albumin replacement on postoperative ileus. Am Surg. 1993;59:758-763.

  12. Durr ED, Hunt DR, Roughneen PT, Andrassy RJ, Rowlands BJ. Hypoalbuminemia and gastrointestinal intolerance to enteral feeding in head injured patients. Gastroenterology. 1986;90:1401.

  13. ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg. 2015;261:1153-1159.

  14. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812-1818.

  15. Miller TE, Roche AM, Mythen M. Fluid management and goaldirected therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can Anesth. 2015;62:158-168.

  16. Brandstrup B, Svendsen PE, Rasmussen M, Belhage B, Rodt SÅ,Hansen B, et al. Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance? Br J Anaesth. 2012;109:191-199.

  17. Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care. 2011;17:290-295.

  18. Marik PE, Lemson J. Fluid responsiveness: an evolution of our understanding. Br J Anaesth. 2014;112:617-620.

  19. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641-648.

  20. Hamilton-Davies C, Mythen MG, Salmon JB, Jacobson D, Shukla A, Webb AR. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med. 1997;23:276-281.

  21. Kheterpal S, Tremper KK, Englesbe MJ, O’Reilly M, Shanks AM, Fetterman DM, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology. 2007;107:892-902.

  22. Srinivasa S, Taylor MH, Sammour T, Kahokehr AA, Hill AG. Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials. Acta Anaesthesiol Scand. 2011;55:4-13.

  23. Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a ‘‘gray zone’’ approach. Anesthesiology. 2011;115:231-241.

  24. Miller TE, Roche AM, Gan TJ. Poor adoption of hemodynamic optimization during surgery are we practicing substandard care? Anesth Analg. 2011;112:1274-1276.

  25. Roche AM, Miller TE, Gan TJ. Goal-directed fluid management with trans-oesophageal Doppler. Best Practice and Research. Clinical Anaesthesiology. 2009;23:327-334

  26. Leibowitz A. Hemodynamic monitoring: from central venous pressure to pulse contour analysis. American Society of Anesthesiologist. 2009;119-128.

  27. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolutionof fast-track surgery. Ann Surg. 2008;248:189-198.

  28. Kassim D, Esmat I. Goal directed fluid therapy reduces major complications in elective surgery for abdominal aortic aneurysm: liberal versus restrictive strategies. Egyptian Journal of Aneshtesia. 2016;32:167-173.

  29. Pestaña D, Espinosa E, Eden A, Nájera D, Collar L, Aldecoa C, et al. Perioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic. Trial: POEMAS Study (PeriOperative goal-directed therapy in Major Abdominal Surgery). Anesth Analg. 2014;119:579-587.

  30. Cannesson M, Ramsingh D, Rinehart J, Demirjian A, Vu T, Vakharia S, et al. Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study. Crit Care. 2015;19:261.

  31. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial. Crit Care. 2005;9:R687-693.

  32. Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patiens: results of prospective randomized study. Crit Care. 2010;14: R118.

  33. Ripollés-Melchor J, Espinosa Á, Martínez-Hurtado E, Abad-Gurumeta A, Casans-Francés R, Fernández-Pérez C, et al. Perioperative goaldirected hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis. J Clin Anesth. 2016;28:105-115.

  34. Hamilton MA, Cecconi M, Rhodes A. A systematic review and metaanalysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392-1402.

  35. Scheeren TW, Wiesenack C, Gerlach H, Marx G. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput. 2013;27:225-233.

  36. Sharkawy O, Refaat E, Ibraheem A, Mahdy W, Fayed N, Mourad W, et al. Transoesophageal Doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection. Saudi J Anaesth. 2013;7:378-386.

  37. Zakhaleva J, Tam J, Denoya PI, Bishawi M, Bergamaschi R. The impact of intravenous fluid administration on complication rates in bowel surgery within an enhanced recovery protocol: a randomized controlled trial. Colorectal Dis. 2013;15:892-899.

  38. Augestad KM, Delaney CP. Postoperative ileus: impact of pharmacological treatment, laparoscopic surgery and enhanced recovery pathways. World J Gastroenterol. 2010;16:2067-2074.

  39. Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Amstrong CA, Lobo DN. Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr. 2015;34:367-376.

  40. Doorly MG, Senagore AJ. Phatogenesis and clinical and economic consequences of postoperative ileus. Surg Clin North Am. 2012;92:259-272.

  41. Asgeirsson T, El Badawi KI, Mahmood A, Barletta J, Luchtefeld M, Senagore AJ. Postoperative ileus: It cost more than you expect. J AmColl Surg. 2010;210:228-231.

  42. Gómez-Izquierdo JC, Trainito A, Mirzakandov D, Stein BL, Liberman S, Charlebois P, et al. Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: a randomized controlled trial. Anesthesiology. 2017;127:36-49.

  43. Elgendy MA, Esmat IM, Kassim DY. Outcome of intraoperative goaldirected therapy using Vigileo/Flotrac in high-risk patients scheduled for major abdominal surgeries: a prospective randomized trial. Egyptian Journal of Anaesthesia. 2017;33:263-269.

  44. Veelo DP, van Berge Henegouwen MI, Ouwehand KS, Geerts BF, Anderegg MC, van Dieren S, et al. Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study. PLoS One. 2017;12:e0172806. doi: 10.1371/journal.pone.0172806.

  45. Bisgaard J, Gilsaa T, Rønholm E, Toft P. Haemodynamic optimisation in lower limb arterial surgery: room for improvement? Acta Anaesthesiol Scand. 2013;57:189-198.

  46. Bisgaard J, Gilsaa T, Rønholm E, Toft P. Optimising stroke volume and oxygen delivery in abdominal aortic surgery: a randomised controlled trial. Acta Anaesthesiol Scand. 2013;57:178-188.

  47. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia. 2016;71:40-45.

  48. Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H. Monitoring of perioperative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand. 2007;51:331-340.

  49. Tote SP, Grounds RM. Performing perioperative optimization of the high-risk surgical patient. BJA: (British Journal of Anaesthesia). 2006;97:4-11.

  50. Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery: a Cochrane Systematic Review. Br J Anaesth. 2013;111:535-548.

  51. Srinivasa S, Lemanu DP, Singh PP, Taylor MH, Hill AG. Systematic review and meta-analysis of oesophageal Doppler-guided fluid management in colorectal surgery. Br J Surg. 2013;100:1701-1708.

  52. Phan TD, D’Souza B, Rattray MJ, Johnston MJ, Cowie BS. A randomised controlled trial of fluid restriction compared to oesophageal dopplerguided goal-directed fluid therapy in elective major colorectal surgery within an enhanced recovery after surgery program. Anaesth Intensive Care. 2014;42:752-760.

  53. Davies SJ, Wilson RJ. Preoperative optimization of the high-risk surgical patient. BJA: (British Journal of Anaesthesia). 2004;93:121-128.

  54. McKenny M, Conroy P, Wong A, Farren M, Gleeson N, Walsh C, et al. A randomised prospective trial of intra-operative oesophageal Doppler-guided fluid administration in major gynaecological surgery. Anaesthesia. 2013;68:1224-1231.

  55. Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013;100:1015-1024.

  56. Zeng K, Li Y, Liang M, Gao Y, Cai H, Lin C. The influence of goal-directed fluid therapy on the prognosis of elderly patients with hypertension and gastric cancer surgery. Drug Des Devel Ther. 2014;8:113-119.




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