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Our study 20 years on: a randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients

Owen Boyd| R. Michael Grounds
My Paper 20 Years Later
Volume 39, Issue 12 / December , 2013

Pages 2107 - 2114

Abstract

Introduction

Goal-directed perioperative therapy (GDT) is now part of a number of international perioperative protocols and, to some extent, seems to have come of age, but no research takes place in isolation and it is valuable to retrospectively look at influential papers to understand the context and influences of the time the research was undertaken.

Methods

One of the earliest publication of a randomised trial of GDT was a study we published 20 years ago in 1993, with co-author Professor E. David Bennett. In this article we describe the work leading up to our research, and look at the historical context of our study and choices we made in designing a protocol.

Conclusion

With 20 years of hindsight we consider the issues that have arisen following our study and place this into the whole of the debate around the use of GDT.

Keywords

References

  1. Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707
    • View reference on PubMed
    • View reference on publisher's website
  2. Cuthbertson DP (1932) Observations on disturbances of metabolism produced by injuries to limbs. Q J Med 1:233–246
  3. Clowes GHA Jr, Del Guercio LRM (1960) Circulatory response to trauma of surgical operations. Metabolism 9:67–81
    • View reference on PubMed
  4. Brown RS, Shoemaker WC (1973) Sequential hemodynamic changes in patients with head injury: evidence for an early hemodynamic defect. Ann Surg 177:187–192
    • View reference on PubMed
    • View reference on publisher's website
  5. Shoemaker WC, Czer LSC (1979) Evaluation of the biologic importance of various haemodynamic and oxygen transport variables. Crit Care Med 7:424–429
    • View reference on PubMed
    • View reference on publisher's website
  6. Bland RD, Shoemaker WC, Abraham E, Cobo JC (1985) Haemodynamic and oxygen transport patterns in surviving and non-surviving patients. Crit Care Med 13:85–90
    • View reference on PubMed
    • View reference on publisher's website
  7. Shoemaker WC, Chang PC, Czer LSC, Bland R, Shabot MM, State D (1979) Cardiorespiratory monitoring in postoperative patients: 1 prediction of outcome and severity of illness. Crit Care Med 7:237–242
    • View reference on PubMed
    • View reference on publisher's website
  8. Bland RD, Shoemaker WC, Shabot MM (1978) Physiologic monitoring goals for the critically ill patient. Surg Gynecol Obstet 147:833–841
    • View reference on PubMed
  9. Babu SC, Pathanjali Sharma PV, Raciti A et al (1980) Monitor-guided responses. Arch Surg 115:1384–1386
    • View reference on PubMed
    • View reference on publisher's website
  10. Whittmore AD, Clowes AW, Hechtman HB, Mannick JA (1980) Aortic aneurysm repair: reduced operative mortality associated with maintenance of optimal cardiac performance. Ann Surg 192:414–420
    • View reference on publisher's website
  11. Rao TLK, Jacobs KH, El-Etr AA (1983) Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 59:499–505
    • View reference on PubMed
    • View reference on publisher's website
  12. Shoemaker WC, Appel PL, Waxman K, Schwartz S, Chang P (1982) Clinical trial of survivors cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit Care Med 10:398–403
    • View reference on PubMed
    • View reference on publisher's website
  13. Shoemaker WC, Appel PL, Bland R (1983) Use of physiologic monitoring to predict outcome and to assist in clinical decisions in critically ill postoperative patients. Am J Surg 1:43–50
    • View reference on publisher's website
  14. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee T-S (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186
    • View reference on PubMed
    • View reference on publisher's website
  15. Cain SM (1977) Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol 42:228–234
    • View reference on PubMed
  16. Schumaker PT, Cain SM (1987) The concept of critical oxygen delivery. Int Care Med 13:223–229
    • View reference on publisher's website
  17. Boyd O, Grounds RM, Bennett ED (1992) The dependency of oxygen consumption on oxygen delivery in critically ill postoperative patients is mimicked by variations in sedation. Chest 101:1619–1624
    • View reference on PubMed
    • View reference on publisher's website
  18. Boyd O, Bennett ED (1992) Is oxygen consumption an important clinical target? In: Vincent JL (ed) Yearbook of intensive care and emergency medicine 1992. Springer, Berlin, pp 310–322
  19. Rhodes A, Lamb FJ, Malagon I, Newman PJ, Grounds RM, Bennett ED (1999) A prospective study of the use of a dobutamine stress test to identify outcome in patients with sepsis, severe sepsis, or septic shock. Crit Care Med 27:2361–2366
    • View reference on PubMed
    • View reference on publisher's website
  20. Vallet B, Chopin C, Curtis SE, Dupuis BA, Fournier F, Mehdaoui H, LeRoy B, Rime A, Santre C, Herbecy P, Her B (1993) Prognostic value of the dobutamine test in patients with sepsis syndrome and normal lactate values: a prospective multicenter study. Crit Care Med 21:1868–1875
    • View reference on PubMed
    • View reference on publisher's website
  21. De Backer D, Berre J, Zhang H, Kahn RJ, Vincent JL (1993) Relationship between oxygen uptake and oxygen delivery in septic patients: effects of prostacyclin versus dobutamine. Crit Care Med 21:1658–1664
    • View reference on PubMed
    • View reference on publisher's website
  22. Schultz RJ, Whitfield GF, LaMura JJ, Raciti A, Krishnamurthy S (1985) The role of physiologic monitoring in patients with fractures of the hip. J Trauma 25:309–316
    • View reference on PubMed
    • View reference on publisher's website
  23. Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130:423–429
    • View reference on PubMed
    • View reference on publisher's website
  24. Valentine RJ, Duke ML, Inman MH, Grayburn PA, Hagino RT, Kakish HB, Clagett GP (1998) Effectiveness of pulmonary artery catheters in aortic surgery: a randomized trial. J Vasc Surg 27:203–211, discussion 211–202
    • View reference on PubMed
    • View reference on publisher's website
  25. Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, McManus E (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 318:1099–1103
    • View reference on PubMed
    • View reference on publisher's website
  26. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M (2003) A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 348:5–14
    • View reference on PubMed
    • View reference on publisher's website
  27. Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059
    • View reference on PubMed
    • View reference on publisher's website
  28. Berlauk JF, Abrams JH, Gilmour IJ, O’Connor SR, Knighton DR, Cerra FB (1991) Preoperative optimisation of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. Ann Surg 214:289–297
    • View reference on PubMed
    • View reference on publisher's website
  29. Bender JS, Smith-Meek MA, Jones CE (1997) Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective, randomized trial. Ann Surg 226:229–236, discussion 236–227
    • View reference on PubMed
    • View reference on publisher's website
  30. Durham RM, Neunaber K, Mazuski JE, Shapiro MJ, Baue AE (1996) The use of oxygen consumption and delivery as endpoints for resuscitation in critically ill patients. J Trauma 41:32–39 discussion, 39–40
    • View reference on PubMed
    • View reference on publisher's website
  31. Ziegler DW, Wright JG, Choban PS, Flancbaum L (1997) A prospective randomized trial of preoperative “optimization” of cardiac function in patients undergoing elective peripheral vascular surgery. Surgery 122:584–592
    • View reference on PubMed
    • View reference on publisher's website
  32. Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. Br Med J 315:909–912
    • View reference on publisher's website
  33. Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97:820–826
    • View reference on PubMed
    • View reference on publisher's website
  34. Intensive Care National Audit and Research Centre (2013) Annual summary statistics. ICNARC. https://www.icnarc.org/CMS/ArticleDisplay.aspx?ID=6c3cc167-5865-dd11-9d92-0015c5e673e7&root=AUDIT&categoryID=3e54947c-6e64-dd11-9d92-0015c5e673e7. Accessed 17 July 2013
  35. Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, Grounds RM, Bennett ED (2006) Identification and characterisation of the high-risk surgical population in the United Kingdom. Critical Care 10:R81
    • View reference on PubMed
    • View reference on publisher's website
  36. Heyland DK, Cook DJ, King D, Kernerman P, Brun-Buisson C (1996) Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Crit Care Med 24:517–524
    • View reference on PubMed
    • View reference on publisher's website
  37. Challand C, Struthers R, Sneyd JR, Erasmus PD, Mellor N, Hosie KB, Minto G (2012) Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. Br J Anaesth 108:53–62
    • View reference on PubMed
    • View reference on publisher's website
  38. Rhodes A, Cecconi M, Hamilton M, Poloniecki J, Woods J, Boyd O, Bennett D, Grounds RM (2010) Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study. Intensive Care Med 36:1327–1332
  39. Juste RN, Lawson AD, Soni N (1996) Minimising cardiac anaesthetic risk: the tortoise or the hare? Anaesthesiology 51:255–262
  40. Boyd O, Hayes M (1999) The oxygen trail—the goal. Br Med Bull 55:125–139
    • View reference on PubMed
    • View reference on publisher's website
  41. Kern JW, Shoemaker WC (2002) Meta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med 30:1686–1692
    • View reference on PubMed
    • View reference on publisher's website
  42. Hamilton MA, Cecconi M, Rhodes A (2011) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 112:1392–1402
    • View reference on PubMed
    • View reference on publisher's website
  43. Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K, Optimisation Systematic Review Steering Group (2013) Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. Br J Anaesth 111(4):535–548
  44. Aya HD, Cecconi M, Hamilton M, Rhodes A (2013) Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth 110:510–517
    • View reference on PubMed
    • View reference on publisher's website
  45. Giglio MT, Marucci M, Testini M, Brienza N (2009) Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 103:637–646
    • View reference on PubMed
    • View reference on publisher's website
  46. Enhanced Recovery Partnership Program (2010) Delivering enhanced recovery: helping patients get better sooner after surgery. Department of Health. http://www.nwlcn.nhs.uk/Downloads/Training-and-events/Delivering_Enhanced_Recovery_Helping_patients_get_better_sooner_after_surgery.pdf. Accessed 17 July 2013
  47. Department of Health NHS improvement and efficiency directorate Innovation and Service Improvement (2011) Innovation Health and Wealth—accelerating adoption and diffusion in the NHS. Department of Health. https://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/document/digitalasset/dh_134597.pdf. Accessed 17 July 2013
  48. Department of Health (2012) High impact innovations—intra-operative fluid management. Department of Health. http://iofm.innovation.nhs.uk/pg/dashboard. Accessed 1 June 2013
  49. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH, Enhanced Recovery after Surgery (ERAS) Group (2009) Consensus review of optimum perioperative care in colorectal surgery: Enhanced Recovery after Surgery (ERAS) Group recommendations. Arch Surg 144:961–969
    • View reference on PubMed
    • View reference on publisher's website
  50. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, MacFie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O (2012) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr 31:783–800
    • View reference on PubMed
    • View reference on publisher's website

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