Master of Science
Introduction: Major abdominal aortic surgery requires significant fluid resuscitation in the post-operative phase. Patients are at significant risk of perioperative morbidity and mortality which can be affected by the approach to post-operative fluid resuscitation. Point of care ultrasonography (POCUS) has evolved as a tool to perform whole-body assessments at the bedside to augment the physical exam and guide the resuscitation of the critically ill. This study will aim to explore the value of rigorous goal-directed resuscitation in aortic surgery using point of care ultrasonography (POCUS).
Methods: In an open-label, randomized, feasibility trial we enrolled 17 patients to receive resuscitation guided by either POCUS or usual care
Results: We observed that the trial protocol as designed met all of our pre-specified feasibility metrics
Conclusion: The use of POCUS in guiding post-operative fluid resuscitation is feasible and utilizing this protocol to design a study powered to detect statistically significant differences in clinical outcomes is warranted.
Summary for Lay Audience
Open abdominal aortic surgery for aortic aneurysms (an abnormal bulge that occurs in the wall of the main major blood vessel that carries blood from your heart to the rest of the body) or occlusive disease (a buildup of plaque that causes decreased blood flow from the aorta to the rest of the body) represents a major surgery for patients. The care of patients after surgery includes administration of intravenous (IV) fluids to support the blood pressure and perfusion to the body’s major organs. There are risks that come with administering too much IV fluid or too little in the post-operative period. This includes the risk of kidney injury from giving too little fluid, or the risk of pulmonary edema (fluid accumulation in the tissue and air spaces of the lungs) or congestive heart failure (fluid overwhelms the heart and causes it to pump inefficiently) from giving too much fluid. The standard practice is for doctors to use a combination of physical examination, urine output, and blood tests to guide the administration of IV fluids after abdominal aortic surgery.
Portable ultrasound can be routinely used to assess heart and lung function at the bedside to add additional information about a patient’s fluid balance and response to fluid administration. This study used a protocol that compared the use of routine ultrasound of the heart and lungs versus standard practice for the first 48 hours after open abdominal aortic surgery. Since this is an innovative approach to taking care of post-operative patients this study first examined whether the protocol we designed was both safe and feasible to carry out. After enrolling 17 patients into the study, we found that all measures of safety and feasibility were met. This now allows us to proceed with the design of a larger trial which uses this same protocol to compare the ultrasound-guided care approach to the standard care approach and see if we can detect any measurable difference in patient outcomes between the two approaches.
Landau, John H., "Ultrasound-Guided Resuscitation in Open Aortic Surgery - The AORTUS Trial" (2020). Electronic Thesis and Dissertation Repository. 7392.
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