Goal directed fluid resuscitation decreases time for lactate clearance and facilitates early fascial closure in damage control surgery

详细信息    查看全文

• 作者：Mira H. Ghneim ; Justin L. Regner ; Daniel C. Jupiter ; Francis Kang ; Gwen L. Bonner ; Melissa S. Bready ; Richard Frazee ; David Ciceri ; Matthew L. Davis
• 关键词：Damage control surgery ; Open abdomen ; Goal-directed therapy ; Early abdominal wall closure ; Early lactate clearance ; Vigileo
• 刊名：The American Journal of Surgery
• 出版年：December, 2013
• 年：2013
• 卷：206
• 期：6
• 页码：995-1000
• 全文大小：132 K

文摘

Background

Damage-control surgery frequently results in open abdomen. The objective of this study was to determine whether resuscitation with goal-directed fluid therapy (GDT) using 鈥渄ynamic鈥?hemodynamic indices via modern pulse contour analysis devices such as the FloTrac Vigileo monitor leads to lower fluid requirements, subsequent quicker abdominal closure, and overall improved outcomes in these patients.

Methods

Patients admitted to the surgical intensive care unit with open abdomen were retrospectively reviewed. Those resuscitated with Vigileo-guided GDT were matched to those resuscitated by static clinical parameters.

Results

Total fluid intake and vasopressor requirements were similar in both groups. GDT with the Vigileo allowed earlier lactate clearance and reduced the number of days until abdominal wall closure by an average of .99 days.

Conclusions

Vigileo-mediated GDT did not affect fluid volume or vasopressor use in open abdomen patients, but facilitated more effective resuscitation and decreased the number of days to fascial closure, leading to shorter hospital stays. Vigileo-mediated GDT, therefore, may improve overall outcomes in open abdomen patients.