Practical impact of a decision support for goal-directed fluid therapy on protocol adherence: a clinical implementation study in patients undergoing major abdominal surgery

AbstractThe purpose of this study was to assess the effects of using a real time clinical decision-support system, “Assisted Fluid Management” (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the pro tocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) <  13%. We hypothesised that patients in the AFM group would have more time during surgery with a SVV <  13% compared to the control group. All patients had a radial arterial line connected to a pulse contour analysis monitor and received a 2 ml/kg/h maintenance crystalloid infusion. Additional 250 ml crystalloid boluses were administered whenever measured SVV ≥ 13% in the control group, and when the software suggested a fluid bolus in the AFM group. We compared 46 AFM-guided patients to 38 controls. Patients in the AFM group spent significantly more time during surgery with a SVV <  13% compared to the control group (median 92% [82, 96] vs. 76% [54, 86]; P <  0.0005), and received less fluid overall (1775 ml [1225, 2425] vs. 2350 ml [1825, 3250]; P = 0.010). The incidence of postoperative complications was comparable in the two groups. Implementation of a decision support system for GDFT guidance resulted in a significantly longer...
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research