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  1. Article ; Online: Intraoperative haemodynamic optimisation using the Hypotension Prediction Index and its impact on tissular perfusion: a protocol for a randomised controlled trial.

    Lorente, Juan Victor / Jimenez, Ignacio / Ripollés-Melchor, Javier / Becerra, Alejandra / Wesselink, Wilbert / Reguant, Francesca / Mojarro, Irene / Fuentes, Maria de Los Angeles / Abad-Motos, Ane / Agudelo, Elizabeth / Herrero-Machancoses, Francisco / Callejo, Paula / Bosch, Joan / Monge, Manuel Ignacio

    BMJ open

    2022  Volume 12, Issue 6, Page(s) e051728

    Abstract: Introduction: Intraoperative arterial hypotension is associated with poor postoperative outcomes. The Hypotension Prediction Index (HPI) developed using machine learning techniques, allows the prediction of arterial hypotension analysing the arterial ... ...

    Abstract Introduction: Intraoperative arterial hypotension is associated with poor postoperative outcomes. The Hypotension Prediction Index (HPI) developed using machine learning techniques, allows the prediction of arterial hypotension analysing the arterial pressure waveform. The use of this index may reduce the duration and severity of intraoperative hypotension in adults undergoing non-cardiac surgery. This study aims to determine whether a treatment protocol based on the prevention of arterial hypotension using the HPI algorithm reduces the duration and severity of intraoperative hypotension compared with the recommended goal-directed fluid therapy strategy and may improve tissue oxygenation and organ perfusion.
    Methods and analysis: We will conduct a multicentre, randomised, controlled trial (N=80) in high-risk surgical patients scheduled for elective major abdominal surgery. All participants will be randomly assigned to a control or intervention group. Haemodynamic management in the control group will be based on standard haemodynamic parameters. Haemodynamic management of patients in the intervention group will be based on functional haemodynamic parameters provided by the HemoSphere platform (Edwards Lifesciences), including dynamic arterial elastance, dP/dt
    Ethics and dissemination: Ethics committee approval was obtained from the Ethics Committee of Hospital Gregorio Marañón (Meeting of 27 July 2020, minutes 18/2020, Madrid, Spain). Findings will be widely disseminated through peer-reviewed publications and conference presentations.
    Trial registration number: NCT04301102.
    MeSH term(s) Arterial Pressure ; Elective Surgical Procedures ; Hemodynamics ; Humans ; Hypotension/diagnosis ; Hypotension/etiology ; Hypotension/prevention & control ; Multicenter Studies as Topic ; Perfusion ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2022-06-02
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-051728
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Association between use of enhanced recovery after surgery protocols and postoperative complications after gastric surgery for cancer (POWER 4): a nationwide, prospective multicentre study.

    Ripollés-Melchor, Javier / Abad-Motos, Ane / Bruna-Esteban, Marcos / García-Nebreda, María / Otero-Martínez, Isabel / Abdel-Lah Fernández, Omar / Tormos-Pérez, María P / Paseiro-Crespo, Gloria / García-Álvarez, Raquel / A Mayo-Ossorio, María / Zugasti-Echarte, Orreaga / Nespereira-García, Paula / Gil-Gómez, Lucia / Logroño-Ejea, Margarita / Risco, Raquel / Parreño-Manchado, Felipe C / Gil-Trujillo, Silvia / Benito, Carmen / Jericó, Carlos /
    De-Miguel-Cabrera, María I / Ugarte-Sierra, Bakarne / Barragán-Serrano, Cristina / García-Erce, José A / Muñoz-Hernández, Henar / Río-Fernández, Sabela Del- / Herrero-Bogajo, María L / Espinosa-Moreno, Alma M / Concepción-Martín, Vanessa / Zorrilla-Vaca, Andrés / Vaquero-Pérez, Laura / Mojarro, Irene / Llácer-Pérez, Manuel / Gómez-Viana, Leticia / Fernández-Martín, María T / Abad-Gurumeta, Alfredo / Ferrando-Ortolà, Carlos / Ramírez-Rodríguez, José M / Aldecoa, César

    Cirugia espanola

    2023  Volume 101, Issue 10, Page(s) 665–677

    Abstract: Introduction: The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocols in gastric cancer surgery remains controversial.: Methods: Multicentre prospective cohort study of adult patients undergoing surgery for gastric cancer. Adherence ...

    Abstract Introduction: The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocols in gastric cancer surgery remains controversial.
    Methods: Multicentre prospective cohort study of adult patients undergoing surgery for gastric cancer. Adherence with 22 individual components of ERAS pathways were assessed in all patients, regardless of whether they were treated in a self-designed ERAS centre. Each centre had a three-month recruitment period between October 2019 and September 2020. The primary outcome was moderate-to-severe postoperative complications within 30 days after surgery. Secondary outcomes were overall postoperative complications, adherence to the ERAS pathway, 30 day-mortality and hospital length of stay (LOS).
    Results: A total of 743 patients in 72 Spanish hospitals were included, 211 of them (28.4 %) from self-declared ERAS centres. A total of 245 patients (33 %) experienced postoperative complications, graded as moderate-to-severe complications in 172 patients (23.1 %). There were no differences in the incidence of moderate-to-severe complications (22.3% vs. 23.5%; OR, 0.92 (95% CI, 0.59 to 1.41); P = 0.068), or overall postoperative complications between the self-declared ERAS and non-ERAS groups (33.6% vs. 32.7%; OR, 1.05 (95 % CI, 0.70 to 1.56); P = 0.825). The overall rate of adherence to the ERAS pathway was 52% [IQR 45 to 60]. There were no differences in postoperative outcomes between higher (Q1, > 60 %) and lower (Q4, ≤ 45 %) ERAS adherence quartiles.
    Conclusions: Neither the partial application of perioperative ERAS measures nor treatment in self-designated ERAS centres improved postoperative outcomes in patients undergoing gastric surgery for cancer.
    Trial registration: ClinicalTrials.gov Identifier NCT03865810.
    MeSH term(s) Adult ; Humans ; Enhanced Recovery After Surgery ; Perioperative Care ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies ; Stomach Neoplasms/surgery ; Stomach Neoplasms/complications
    Language English
    Publishing date 2023-04-23
    Publishing country Spain
    Document type Journal Article ; Multicenter Study
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.cireng.2023.04.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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