Assisted Fluid Management Software Guidance for Intraoperative Fluid Administration.

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Maheshwari, Kamal

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Malhotra, Gaurav

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Bao, Xiaodong

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Lahsaei, Peiman

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Hand, William R

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Fleming, Neal W

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Ramsingh, Davinder

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Treggiari, Miriam M

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Sessler, Daniel I

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Miller, Timothy E

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Assisted Fluid Management Study Team

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2022-04-04T12:15:49Z

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2022-04-04T12:15:49Z

dc.date.issued

2021-08

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2022-04-04T12:15:48Z

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Background

Excessive or inadequate fluid administration causes complications, but despite this, fluid administration during noncardiac surgery is highly variable. Goal-directed management helps optimize the amount and timing of fluid administration; however, implementation is difficult because algorithms are complex. The authors therefore tested the performance of the Acumen Assisted Fluid Management software (Edwards Lifesciences, USA), which is designed to guide optimal intravenous fluid administration during surgery.

Methods

In this multicenter, prospective, single-arm cohort evaluation, the authors enrolled 330 adults scheduled for moderate- to high-risk noncardiac surgery that required arterial catheter insertion and mechanical ventilation. Clinicians chose a fluid strategy based on a desired 10%, 15%, or 20% increase in stroke volume (SV) in response to a fluid bolus. Dedicated fluid management software prompted "test" or "recommended" boluses, and clinicians were free to initiate a "user" bolus of 100 to 500 ml of crystalloid or colloid. Clinicians were free to accept or decline the software prompts. The authors primarily compared the fraction of software-recommended boluses that produced suitable increases in SV to a 30% reference rate. On an exploratory basis, we compared responses to software-recommended and clinician-initiated boluses.

Results

Four hundred twenty-four of 479 (89%) software-recommended fluid boluses and 508 of 592 (86%) clinician-initiated fluid boluses were analyzed per protocol. Of those, 66% (95% CI, 62 to 70%) of delivered fluid boluses recommended by the software resulted in desired increases in SV, compared with the 30% reference rate, whereas only 41% (95% CI, 38 to 44%) of clinician-initiated boluses did (P < 0.0001). The mean ± SD increase in SV after boluses recommended by the software was 14.2 ± 13.9% versus 8.3 ± 12.1% (P < 0.0001) for those initiated by clinicians.

Conclusions

Fluid boluses recommended by the software resulted in desired SV increases more often, and with greater absolute SV increase, than clinician-initiated boluses. Automated assessment of fluid responsiveness may help clinicians optimize intraoperative fluid management during noncardiac surgery.

Editor’s perspective

dc.identifier

115682

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0003-3022

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1528-1175

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https://hdl.handle.net/10161/24781

dc.language

eng

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Ovid Technologies (Wolters Kluwer Health)

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Anesthesiology

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10.1097/aln.0000000000003790

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Assisted Fluid Management Study Team

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Humans

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Fluid Therapy

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Intraoperative Care

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Therapy, Computer-Assisted

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Cohort Studies

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Aged

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Middle Aged

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Female

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Male

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Assisted Fluid Management Software Guidance for Intraoperative Fluid Administration.

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Journal article

duke.contributor.orcid

Treggiari, Miriam M|0000-0003-4639-3682

duke.contributor.orcid

Miller, Timothy E|0000-0001-8567-6680

pubs.begin-page

273

pubs.end-page

283

pubs.issue

2

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Duke

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School of Medicine

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Clinical Science Departments

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Anesthesiology

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Anesthesiology, Critical Care Medicine

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Anesthesiology, General, Vascular, High Risk Transplant & Critical Care

pubs.publication-status

Published

pubs.volume

135

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