Impact of goal-directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before-and-after pilot study

被引：2
作者：
Philteos, Justine [1 ]
Mccluskey, Stuart A. [2 ,3 ]
Emerson, Sophia [2 ,3 ]
Djaiani, George [2 ,3 ]
Goldstein, David [1 ]
Soussi, Sabri [2 ,4 ,5 ]
机构：
[1] Univ Toronto, Univ Hlth Network, Dept Otolaryngol Head & Neck Surg, Toronto, ON, Canada
[2] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada
[3] Univ Hlth Network, Toronto Gen Hosp, Dept Anesthesia & Pain Management, Toronto, ON, Canada
[4] Univ Hlth Network, Toronto Western Hosp, Dept Anesthesia & Pain Management, Toronto, ON, Canada
[5] Univ Hlth Network, Toronto Western Hosp, Dept Anesthesia & Pain Management, Room McL2-405,399 Bathurst St, Toronto, ON M5T 2S8, Canada
来源：
HEALTH SCIENCE REPORTS | 2024年 / 7卷 / 03期
关键词：
cardiac output; head and neck free flap surgery; hemodynamic monitoring; intraoperative hypotension; postoperative outcomes; RANDOMIZED CLINICAL-TRIAL; FREE TISSUE TRANSFER; INTRAOPERATIVE HYPOTENSION; FLUID OVERLOAD; HOSPITAL STAY; ACUTE KIDNEY; RECONSTRUCTION; RISK; COMPLICATIONS; MANAGEMENT;
D O I：
10.1002/hsr2.1943
中图分类号：
R1 [预防医学、卫生学];
学科分类号：
1004 ; 120402 ;
摘要：
Background Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the intraoperative use of goal-directed hemodynamic therapy (GDHT) is associated with a reduction in the number of IOH events in this population. Methods A before-and-after study design. The patients who had intraoperative GDHT were compared to patients from a previous period before the implementation of GDHT. The primary outcome was the number of IOH episodes defined as five or more successive minutes with a mean arterial pressure <65 mmHg. The secondary outcomes included major postoperative morbidity and 30-day mortality. Results A total of 414 patients were included. These were divided into two groups. The control group (n = 346; January 1, 2018, to December 31, 2019), and the monitored group (n = 68; January 1, 2020, to May 1, 2021). The median intraoperative administered fluid volume was similar between the control and monitored groups (2250 interquartile range [IQR] [1607-3050] vs. 2210 IQR [1700-2807] mL). The monitored group was found to have an increased use of norepinephrine and dobutamine (respectively, 1.2% vs. 5.9% and 2.4% vs. 30.9%; p < 0.05). When adjusting for confounders (comorbidities, estimated blood loss, and duration of anesthesia) the incidence rate ratio (95% confidence interval) of number of IOH events was 0.94 (0.86-1.03), p = 0.24. The rate of postoperative flap and medical complications did not differ between the two groups. Conclusions Even though the use of vasopressors/inotropes was higher in the monitored group, the number of IOH episodes and postoperative morbidity and mortality were similar between the two groups. Further change in hemodynamic management will require the use of specific blood pressure targets in the GDHT fluid algorithm.
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页数：9
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