Effect Of Using Trans-Esophageal Echocardiography Guided Goal-Directed Hemodynamic Therapy Compared To Conventional Hemodynamic Management In Reducing Post-Operative Pulmonary Complications In Elective Major Open Abdominal Surgery Under General Anesthesia

Abstract

Background: Pulmonary complications result in a significant rise in morbidity, mortality, and duration of hospitalization, particularly following major upper abdominal operations. The work aimed to reduce the rate of postoperative pulmonary complications (PPCs) following a major abdominal operation.

Methods: This randomized controlled trial study has been performed on 160 cases over the age of eighteen, both sexes, American Society of Anesthesiologists I, II, III physical status, underwent elective major abdominal operation. Cases were categorized to 2 equal groups: Goal-directed therapy (GDT): transesophageal echocardiography (TEE)-guided algorithm and control group: with conventional hemodynamic managing according to standard operating procedures.

Results: Post complications development (pulmonary complications) and intra-operative complication development (hypovolemia and fluid balance) were significantly lesser in in GDT group compared to control group. The duration of hospital stays and need for vasopressors were significantly lesser in GDT group compared to control group (P<0.05). Assessing respiratory risk in surgical cases in Catalonia severity, central venous pressure, heart rate, mean arterial blood pressure, oxygen saturation, & physical status were insignificantly variant among the examined groups.

Conclusions: TEE-guided intraoperative hemodynamic management was correlated with a reduced incidence of intraoperative complications in extended, major abdominal surgeries, especially hypovolemia, a lower need for inotrope and a lower frequency of pulmonary complications. It is also beneficial for reducing the length of hospitalization compared to standard care.