Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery : the multicentre randomised iPEGASUS trial
Funcke, S. (University Medical Center Hamburg-Eppendorf)
Schmidt, G. (Justus-Liebig-University Giessen)
Bergholz, A. (University Medical Center Hamburg-Eppendorf)
Argente Navarro, P. (Hospital Universitari i Politècnic La Fe (València))
Azparren Cabezón, Gonzalo (Institut de Recerca Sant Pau)
Barbero-Espinosa, Silvia (Institut de Recerca Sant Pau)
Diaz-Cambronero, Oscar (Hospital Universitari i Politècnic La Fe (València))
Edinger, F. (Justus-Liebig-University Giessen)
García-Gregorio, N. (Hospital Universitari i Politècnic La Fe (València))
Habicher, M. (Justus-Liebig-University Giessen)
Klinkmann, G. (Fraunhofer Institute for Cell Therapy and Immunology)
Koch, Christian (Justus-Liebig-University Giessen)
Kröker, A. (University Medical Center Hamburg-Eppendorf)
Mencke, T. (University Medical Centre of Rostock)
Moral García, V. (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Zitzmann, A. (University Medical Centre of Rostock)
Lezius, S. (University Medical Center Hamburg-Eppendorf)
Pepić, A. (University Medical Center Hamburg-Eppendorf)
Sessler, Daniel (Outcomes Research Consortium)
Sander, M. (Justus-Liebig-University Giessen)
Haas, S.A. (University Medical Centre of Rostock)
Reuter, D.A. (University Medical Centre of Rostock)
Saugel, B. (Outcomes Research Consortium)
Universitat Autònoma de Barcelona

Date:	2024
Abstract:	It is unclear whether optimising intraoperative cardiac index can reduce postoperative complications. We tested the hypothesis that maintaining optimised postinduction cardiac index during and for the first 8 h after surgery reduces the incidence of a composite outcome of complications within 28 days after surgery compared with routine care in high-risk patients having elective major open abdominal surgery. In three German and two Spanish centres, high-risk patients having elective major open abdominal surgery were randomised to cardiac index-guided therapy to maintain optimised postinduction cardiac index (cardiac index at which pulse pressure variation was <12%) during and for the first 8 h after surgery using intravenous fluids and dobutamine or to routine care. The primary outcome was the incidence of a composite outcome of moderate or severe complications within 28 days after surgery. We analysed 318 of 380 enrolled subjects. The composite primary outcome occurred in 84 of 152 subjects (55%) assigned to cardiac index-guided therapy and in 77 of 166 subjects (46%) assigned to routine care (odds ratio: 1. 87, 95% confidence interval: 1. 03-3. 39, P=0. 038). Per-protocol analyses confirmed the results of the primary outcome analysis. Maintaining optimised postinduction cardiac index during and for the first 8 h after surgery did not reduce, and possibly increased, the incidence of a composite outcome of complications within 28 days after surgery compared with routine care in high-risk patients having elective major open abdominal surgery. Clinicians should not strive to maintain optimised postinduction cardiac index during and after surgery in expectation of reducing complications. Clinical trial registration: NCT03021525.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Anaesthesia ; Cardiac output ; Cardiovascular dynamics ; Haemodynamic monitoring ; Individualised ; Morbidity ; Mortality ; Randomised controlled trial
Published in:	British journal of anaesthesia, Vol. 133 Núm. 2 (august 2024) , p. 277-287, ISSN 1471-6771

DOI: 10.1016/j.bja.2024.03.040
PMID: 38797635

11 p, 606.3 KB

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