A protocolized-personalized approach for hemodynamics management in major abdominal surgery

Kharlamov K.E.

Institute of General Resuscitation Federal Research and Clinical Center for Reanimatology and Rehabilitology

Yadgarov M.Ya.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation

Berikashvili L.B.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation

Kadantseva K.K.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation;
Moscow Clinical Scientific and Practical Center named after A.S. Loginov Department of Health of Moscow

Likhvantsev V.V.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation

Gracheva N.D.

Institute of General Resuscitation Federal Research and Clinical Center for Reanimatology and Rehabilitology

Grebenchikov O.A.

Federal Research and Clinical Center for Intensive Care and Rehabilitation

A protocolized-personalized approach for hemodynamics management in major abdominal surgery

Authors:

Kharlamov K.E., Yadgarov M.Ya., Berikashvili L.B., Kadantseva K.K., Likhvantsev V.V., Gracheva N.D., Grebenchikov O.A.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2023;(1): 56‑62

DOI: 10.17116/anaesthesiology202301156

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To cite this article:

Kharlamov KE, Yadgarov MYa, Berikashvili LB, Kadantseva KK, Likhvantsev VV, Gracheva ND, Grebenchikov OA. A protocolized-personalized approach for hemodynamics management in major abdominal surgery. Russian Journal of Anesthesiology and Reanimatology. 2023;(1):56‑62. (In Russ.)
https://doi.org/10.17116/anaesthesiology202301156

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OBJECTIVE

To evaluate the impact of a protocolized-personalized approach to hemodynamic management (PPHM) on 30-day mortality in elderly patients undergoing major abdominal surgery and to determine predictors of mortality.

MATERIAL AND METHODS

A retrospective-prospective clinical study of PPHM effectiveness in perioperative period of major abdominal surgery in elderly patients was carried out. We analyzed the effect of non-modifiable (gender, age, comorbidities) and modifiable (cardiac index, NT-proBNP, surgery time, duration of anesthesia) factors on 30-day mortality.

RESULTS

A total of 90 patients treated with PPHM were eligible for inclusion/exclusion criteria and retrospectively matched with 89 historical control patients with standard postoperative management. There was no significant relationship between PPHM and 30-day mortality (p=0.813). PPHM was followed by shorter ICU-stay (2 (1.0-8.3) days vs. 6 (2.0-16.5) days; p<0.001) and hospital-stay (12 (10-20) days vs. 18 (12-26) days; p<0.001). Multivariate regression analysis identified two independent predictors of mortality: age ≥72 years (adj. OR 12.37; 95% CI 3.38-45.36, p<0.001) and cardiac index at admission ≤2.1 L/min /m² (adj. OR 4.80; 95% CI 1.28-18.06; p=0.02).

CONCLUSION

Age over 72 years and lower cardiac index at admission (≤2.1 L/min/m²) are associated with higher mortality risk. PPHM in patients undergoing major abdominal surgery was not associated with any changes in 30-day mortality. However, this approach reduces ICU-stay and hospital-stay.

Keywords:

abdominal surgery

hemodynamics

mortality

cardiac index

NT-proBNP

Authors:

Kharlamov K.E.

Institute of General Resuscitation Federal Research and Clinical Center for Reanimatology and Rehabilitology

Yadgarov M.Ya.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation

Berikashvili L.B.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation

Kadantseva K.K.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation;
Moscow Clinical Scientific and Practical Center named after A.S. Loginov Department of Health of Moscow

Likhvantsev V.V.

Federal Scientific and Clinical Center of Intensive Care and Rehabilitation

Gracheva N.D.

Institute of General Resuscitation Federal Research and Clinical Center for Reanimatology and Rehabilitology

Grebenchikov O.A.

Federal Research and Clinical Center for Intensive Care and Rehabilitation

Received:

29.07.2022

Accepted:

28.09.2022

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