Help
Subscribe


Submit Videos to GastroHep Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Cardiac output–guided hemodynamic therapy algorithm reduces complications after GI surgery

This week's Journal of the American Medical Association evaluates the effect of a perioperative, cardiac output–guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery.

News image

Small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.

Dr Rupert Pearse and colleagues evaluated the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.

OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom.

An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to 2014.

Patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery or to usual care.

The primary outcome occurred in 37% of intervention participants 
JAMA

The team's primary outcome was a composite of predefined 30-day moderate or major complications and mortality.

Secondary outcomes were morbidity on day 7, with infection, critical care–free days, and all-cause mortality at 30 days, all-cause mortality at 180 days, and length of hospital stay.

Baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups.

Care was nonadherent to the allocated treatment for less than 10% of patients in each group.

The team found that the primary outcome occurred in 37% of intervention and 43% of usual care participants.

The researchers found no significant difference between groups for any secondary outcomes.

The team noted that 5 intervention patients experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group.

Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications, and a nonsignificant reduction in hospital, 28-day, or 30-day mortality, and mortality at longest follow-up.

Dr Pearse's team concludes, "In a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality."

"However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rates."

JAMA 2014; 311(21):2181-2190 
06 June 2014

Go to top of page Email this page Email this page to a colleague

 20 August 2014

Advanced search
 20 August 2014 
Stool methylated DNA markers and colorectal cancer resection
 20 August 2014 
Rectal surgery mortality
 20 August 2014 
Chemotherapy-induced gastrointestinal mucositis
 19 August 2014 
Recurrent C. difficile infection in out-patients
 19 August 2014 
Racial disparities and colon cancer
 19 August 2014 
Variability of colonoscopy preparation instructions
 18 August 2014 
The evolution of urban C. difficile
 18 August 2014 
Metabolomic analysis in IBD
 18 August 2014 
Enhanced T-cell response in acute-on-chronic Hep B
 15 August 2014 
Abdominal pain in IBS
 15 August 2014 
Gene expression biomarker in ulcerative colitis
 15 August 2014 
Population-based fecal immunochemical test screening
 14 August 2014 
Transnasal vs transoral endoscopy
 14 August 2014 
Radiation exposure in gastroenterology
 14 August 2014 
Dietary fibre and diverticular disease
 13 August 2014 
Adherence to Rome criteria in functional dyspepsia
 13 August 2014 
Fecal immunochemical test screening
 13 August 2014 
Flexible sigmoidoscopy screening
 12 August 2014 
Eosinophilic esophagitis and celiac disease
 12 August 2014 
Management of Lynch syndrome
 12 August 2014 
Risk of cancer under immunosuppressive therapy in IBD
 11 August 2014 
Gut microbiota in chemotherapy-induced GI mucositis
 11 August 2014 
Risk of GI bleeds with anticoagulants
 11 August 2014 
Social media in health-care
 08 August 2014 
Surgeon volume and esophagectomy survival
 08 August 2014 
Endoscopy nurse-administered propofol sedation performance
 08 August 2014 
Therapy for biliary tract cancer
 07 August 2014 
Smoking cessation and age of onset of ulcerative colitis
 07 August 2014 
Global consensus on perianal fistulizing Crohn's disease
 07 August 2014 
Colonoscopy length and training duration
 06 August 2014 
Hepatitis C virus infection in the United States
 06 August 2014 
Pediatric to adult IBD care
 06 August 2014 
Biomarker of disease activity in IBD
 05 August 2014 
Rising incidence of celiac disease
 05 August 2014 
Socioeconomic status and IBS
 05 August 2014 
Bowel dysfunction after sphincter-preserving rectal cancer surgery
 04 August 2014 
Relative adrenal insufficiency and chronic liver disease
 04 August 2014 
Colonoscopy screening protocol for liver transplant recipients
 04 August 2014 
Patient-reported outcomes after upper GI bleed
 01 August 2014 
Capsule colonoscopy vs CT colonography for polyp screening
 01 August 2014 
Complications after obesity surgery
 01 August 2014 
Fully covered self-expanding metal stents for benign biliary strictures
 31 July 2014 
Diverticular disease and colon cancer
 31 July 2014 
Biomarkers in liver fibrosis
 31 July 2014 
Risk factors of large colorectal polyps
 30 July 2014 
Interval between screening colonoscopies
 30 July 2014 
Small intestinal permeability in diarrhea predominant IBS
 30 July 2014 
Mineral rich water and constipation
 29 July 2014 
Fluticasone in eosinophilic esophagitis
 29 July 2014 
Causes of GI bleeding in cirrhosis
 29 July 2014 
ALT increases in Hep B
 28 July 2014 
Statins reduce Barrett's
 28 July 2014 
Score predicts risk for Barrett’s esophagus
 28 July 2014 
Gastric cancer prevention
 25 July 2014 
De-escalation of therapy in IBD
 25 July 2014 
Bionic pancreas in type 1 diabetes
 25 July 2014 
Primary care physician counselling and colonoscopy
 24 July 2014 
Diagnostic tool for obscure-overt GI bleeding
 24 July 2014 
Statin use and Barrett’s esophagus
 24 July 2014 
Atopy and functional GI disorders

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2014 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us