Respiratory Exchange Ratio guided management in high-risk noncardiac surgery: The OPHIQUE multicentre randomised controlled trial - 22/07/23
, Mouhamed Djahoum Moussa c, Richard Descamps d, Younes El Amine e, Belaid Bouhemad f, g, Marc-Olivier Fischer d, h, Emmanuel Lorne i, Hervé Dupont a, b, Momar Diouf j, Pierre Grégoire Guinot f, gOPtimization Hemodynamic Individualized using the respiratiory QUotiEnt (OPHIQUE) Trial Group1
Highlights |
• | There is a need to develop non-invasive markers to identify tissue hypoperfusion. |
• | The Respiratory Exchange Ratio is a non-invasive marker of tissue perfusion. |
• | Does algorithm based on the Respiratory Exchange Ratio reduce complications? |
• | The Respiratory Exchange Ratio did not reduce postoperative complications. |
Abstract |
Background |
There is a need to develop non-invasive markers to identify the occurrence of anaerobic metabolism in high-risk surgery. Our objective was to demonstrate that a goal-directed therapy algorithm incorporating the respiratory exchange ratio (ratio between CO2 production and O2 consumption) can reduce postoperative complications.
Methods |
We conducted a randomized, multicenter, controlled clinical trial in four university medical centers and one non-university hospital from December 26, 2018, to September 9, 2021. 350 patients with a high risk of postoperative complications undergoing high-risk noncardiac surgery lasting 2 h or longer under general anesthesia were enrolled. The control group was treated according to current hemodynamic guidelines. The interventional group was treated according to an algorithm based on the measurement of the respiratory exchange ratio. The primary outcome was a composite of major complications or death within seven days of surgery. The secondary outcomes were the length of hospital stay, 30-day mortality, and the total intraoperative volume of fluids administered.
Results |
The primary outcome occurred for 78 patients (45.6%) in the interventional group and 83 patients (48.8%) in the control group (relative risk: 0.93, 95% confidence interval [CI]: 0.75–1.17; p = 0.55). There were no clinically relevant differences between the two groups for secondary outcomes.
Conclusions |
In high-risk surgery, a goal-directed therapy algorithm integrating the measurement of the respiratory-exchange ratio did not reduce a composite outcome of major postoperative complications or death within seven days after surgery compared to routine care.
Trial Registration |
ClinicalTrials.gov, NCT03852147.
Le texte complet de cet article est disponible en PDF.Abbreviations : ASA-PS, CI, CO, CONSORT, ERAS, EPCO, FiO2, FetO2, FiCO2, FetCO2, GDT, DO2, PaO2, RELIEF, RER, VCO2, SOFA, SpO2, SD, SBP, VO2
Keywords : Anaerobic metabolism, Goal-directed therapy, High-risk surgery, Organ failure, Oxygen uptake
Plan
Vol 42 - N° 4
Article 101221- août 2023 Retour au numéro
Article précédent
- Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial
- Sarah M. Amin, Ahmed Hasanin, Omnia S. ElSayed, Maha Mostafa, Dalia Khaled, Amany S. Arafa, Amany Hassan
- Scalpel cricothyrotomy versus punctured cricothyrotomy in the context of the CICO crisis. A systematic review and Meta-analysis
- Qirui Duan, Dong Yang, Huibin Gao, Quanle Liu, Juan Zhi, Jin Xu, Weipeng Xia
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?