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Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes

Scoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemo...

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Autores principales: Miegoń, Jakub, Zacha, Sławomir, Skonieczna-Żydecka, Karolina, Wiczk-Bratkowska, Agata, Andrzejewska, Agata, Jarosz, Konrad, Deptuła-Jarosz, Monika, Biernawska, Jowita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453073/
https://www.ncbi.nlm.nih.gov/pubmed/37628370
http://dx.doi.org/10.3390/children10081371
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author Miegoń, Jakub
Zacha, Sławomir
Skonieczna-Żydecka, Karolina
Wiczk-Bratkowska, Agata
Andrzejewska, Agata
Jarosz, Konrad
Deptuła-Jarosz, Monika
Biernawska, Jowita
author_facet Miegoń, Jakub
Zacha, Sławomir
Skonieczna-Żydecka, Karolina
Wiczk-Bratkowska, Agata
Andrzejewska, Agata
Jarosz, Konrad
Deptuła-Jarosz, Monika
Biernawska, Jowita
author_sort Miegoń, Jakub
collection PubMed
description Scoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemodynamic monitoring and goal-directed therapy in relation to patient outcomes following posterior fusion surgery for adolescent idiopathic scoliosis (AIS). The control group (n = 35, mean age: 15 years) received standard blood pressure management during the surgical procedure, whereas the intervention group (n = 35, mean age: 14 years) underwent minimally invasive haemodynamic monitoring. Arterial pulse contour analysis (APCO) devices were employed, along with goal-directed therapy protocol centered on achieving target mean arterial pressure and stroke volume. This was facilitated through the application of crystalloid boluses, ephedrine, and noradrenaline. The intervention group was subjected to a comprehensive protocol following Enhanced Recovery After Surgery (ERAS) principles. Remarkably, the intervention group exhibited notable advantages (p < 0.05), including reduced hospital stay durations (median 7 days vs. 10), shorter episodes of hypotension (mean arterial pressure < 60 mmHg—median 8 vs. 40 min), lesser declines in postoperative haemoglobin levels (−2.36 g/dl vs. −3.83 g/dl), and quicker extubation times. These compelling findings strongly imply that the integration of targeted interventions during the intraoperative care of AIS patients undergoing posterior fusion enhance a set of treatment outcomes.
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spelling pubmed-104530732023-08-26 Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes Miegoń, Jakub Zacha, Sławomir Skonieczna-Żydecka, Karolina Wiczk-Bratkowska, Agata Andrzejewska, Agata Jarosz, Konrad Deptuła-Jarosz, Monika Biernawska, Jowita Children (Basel) Article Scoliosis surgery is a challenge for the entire team in terms of safety, and its accomplishment requires the utilization of advanced monitoring technologies. A prospective, single centre, non-randomised controlled cohort study, was designed to assess the efficacy of protocolised intraoperative haemodynamic monitoring and goal-directed therapy in relation to patient outcomes following posterior fusion surgery for adolescent idiopathic scoliosis (AIS). The control group (n = 35, mean age: 15 years) received standard blood pressure management during the surgical procedure, whereas the intervention group (n = 35, mean age: 14 years) underwent minimally invasive haemodynamic monitoring. Arterial pulse contour analysis (APCO) devices were employed, along with goal-directed therapy protocol centered on achieving target mean arterial pressure and stroke volume. This was facilitated through the application of crystalloid boluses, ephedrine, and noradrenaline. The intervention group was subjected to a comprehensive protocol following Enhanced Recovery After Surgery (ERAS) principles. Remarkably, the intervention group exhibited notable advantages (p < 0.05), including reduced hospital stay durations (median 7 days vs. 10), shorter episodes of hypotension (mean arterial pressure < 60 mmHg—median 8 vs. 40 min), lesser declines in postoperative haemoglobin levels (−2.36 g/dl vs. −3.83 g/dl), and quicker extubation times. These compelling findings strongly imply that the integration of targeted interventions during the intraoperative care of AIS patients undergoing posterior fusion enhance a set of treatment outcomes. MDPI 2023-08-10 /pmc/articles/PMC10453073/ /pubmed/37628370 http://dx.doi.org/10.3390/children10081371 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Miegoń, Jakub
Zacha, Sławomir
Skonieczna-Żydecka, Karolina
Wiczk-Bratkowska, Agata
Andrzejewska, Agata
Jarosz, Konrad
Deptuła-Jarosz, Monika
Biernawska, Jowita
Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
title Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
title_full Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
title_fullStr Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
title_full_unstemmed Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
title_short Optimising Intraoperative Fluid Management in Patients Treated with Adolescent Idiopathic Scoliosis—A Novel Strategy for Improving Outcomes
title_sort optimising intraoperative fluid management in patients treated with adolescent idiopathic scoliosis—a novel strategy for improving outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453073/
https://www.ncbi.nlm.nih.gov/pubmed/37628370
http://dx.doi.org/10.3390/children10081371
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