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You searched for +publisher:"McGill University" +contributor:("Gabriele Baldini"). Showing records 1 – 2 of 2 total matches.

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McGill University

1. Cicala, Silvia. Fluid responsiveness in the postoperative period: a prospective study in non-critically ill patients.

Degree: MS, Department of Surgery, 2018, McGill University

Background: The incidence of Fluid Responsiveness (FR) in non-critically ill surgical patients and the proportion of patients in whom Stroke Volume (SV) significantly increases after a bolus of intravenous fluids (Volume Expansion, VE) are unknown after surgery. Although being Fluid Responder (FRer) does not necessarily imply being hypovolemic, it remains to be determined whether postoperative FR is associated with complications. Objectives: The aims of this prospective study are to determine 1) the incidence of FR in non-critically ill surgical patients after major surgeries, 2) if postoperative FR is associated with and predicts 30-day complications, 3) the proportion of patients in whom SV significantly increases after VE.Methods: Ethic approval: 14-452-SDR; ClinicalTrials.gov number, NCT02418663. Adult patients undergoing major thoracic or abdominal surgery, not requiring intensive care unit admission, and treated with a surgery-specific Enhanced Recovery Program were enrolled. FR was assessed soon after surgery, and daily for the first 48 h. SV was measured with the ccNexfin® just before and 1 min after a fluid challenge (FC) with 250 ml of Lactated Ringer's over 5 min. FR was also assessed "on call" when VE was clinically deemed. A patient was considered fluid responder (FRer) if SV increased by 15% either 1 min after the FC or 1 min after VE, at least 1 time within 48 h. Treating physicians were blind to all SV measurements. Results: FR after a FC was present in 52 over 172 patients (30.2%). Complications occurred in 53.8% of FRer and in 45% of non-FRer (Relative Risk, RRcrude= 1.19, 95% Confidence Interval, CI=0.86 to 1.64, p-value=0.286; RRadjusted =1.08, 95%CI=0.68 to 1.70, p-value=0.719). After controlling for confounders (age, duration of surgery, intraoperative blood loss and volume of intravenous fluids, and postoperative negative fluid balance) FR was not an independent predictor of complications (Odds Ratio, ORcrude =1.16 95%CI=0.68 to 2.01, p-value=0.579; ORadjusted=0.98 95%CI=0.42 to 2.26, p-value=0.965). "On call FR" was measured in 15 patients (8.7%); of these, only 4 (26.7%) were FRer. Conclusions: Thirty-percent of non-critically ill surgical patients are FRer after surgery. After controlling for confounders, FR is not associated with and it does not predict 30-day complications. Finally, fluid boluses administered on the basis of clinical signs of hypovolemia rarely determine a significant increase of SV and might be potentially harmful.

Avant-propos : L'incidence de la Réponse au Remplissage Vasculaire (RRV) chez les patients chirurgicaux non critiques et la proportion des patients dans lesquels le Débit Systolique (DS) augmente significativement après d'un bolus de fluides intraveineuses (Expansion Volémique, EV) ne sont pas connus après de la chirurgie. Bien qu'être Répondeur aux remplissage vasculaire (ReurRV) n'implique nécessairement être hypovolémique, il reste encore à déterminer si la RRV postopératoire soit associée avec des complications.Objectif :Cette étude perspective est…

Advisors/Committee Members: Gabriele Baldini (Internal/Supervisor).

Subjects/Keywords: Surgery

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Cicala, S. (2018). Fluid responsiveness in the postoperative period: a prospective study in non-critically ill patients. (Masters Thesis). McGill University. Retrieved from http://digitool.library.mcgill.ca/thesisfile161391.pdf

Chicago Manual of Style (16th Edition):

Cicala, Silvia. “Fluid responsiveness in the postoperative period: a prospective study in non-critically ill patients.” 2018. Masters Thesis, McGill University. Accessed February 20, 2020. http://digitool.library.mcgill.ca/thesisfile161391.pdf.

MLA Handbook (7th Edition):

Cicala, Silvia. “Fluid responsiveness in the postoperative period: a prospective study in non-critically ill patients.” 2018. Web. 20 Feb 2020.

Vancouver:

Cicala S. Fluid responsiveness in the postoperative period: a prospective study in non-critically ill patients. [Internet] [Masters thesis]. McGill University; 2018. [cited 2020 Feb 20]. Available from: http://digitool.library.mcgill.ca/thesisfile161391.pdf.

Council of Science Editors:

Cicala S. Fluid responsiveness in the postoperative period: a prospective study in non-critically ill patients. [Masters Thesis]. McGill University; 2018. Available from: http://digitool.library.mcgill.ca/thesisfile161391.pdf

2. Gómez Izquierdo, Juan Camilo Ernesto. Goal directed fluid therapy and gastrointestinal function after abdominal surgery.

Degree: PhD, Department of Surgery, 2017, McGill University

Title: "Goal directed fluid therapy and gastrointestinal function after abdominal surgery"Introduction: Goal directed fluid therapy (GDFT) aims at optimizing oxygen delivery by administering intravenous fluids, with or without inotropes, based on the assessment of stroke volume or cardiac output. It has demonstrated to decrease perioperative morbidity mostly in high-risk patients. However, very few studies have primarily investigated the impact of GDFT on the occurrence of primary postoperative ileus (PPOI). PPOI in the absence of surgical complications constitutes an important economic burden for healthcare systems, since it increases postoperative morbidity and delays hospital discharge. GDFT can prevent the occurrence of both hypovolemia and fluid overload by administrating intravenous fluids based on more objective measures of the intravascular volume.The objectives of this thesis are 1) to review the evidence supporting the use of GDFT to facilitate the recovery of bowel function after abdominal surgery, 2) investigate whether GDFT compared to traditional fluid administration can reduce the incidence of PPOI after laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery Program, 3) and determine the effect of GDFT on sub-lingual microcirculation, as a surrogate measure of splanchnic tissue perfusion. Methods: First, a systematic review of the literature and meta-analysis was performed to evaluate the effects of GDFT on the recovery of bowel function after abdominal surgery. Second, a randomized controlled trial comparing intraoperative GDFT with a traditional fluid administration technique was conducted in patients undergoing laparoscopic colorectal surgery in the context of an ERAS program; PPOI was the primary outcome. Finally, perioperative sub-lingual microcirculatory measurements were acquired in a subgroup of patients to analyze the microcirculatory effects of the 2 different fluid strategies. Results: the results of the systematic review and meta-analysis indicated that GDFT facilitated the recovery of bowel function, particularly in patients not treated within an ERAS program and in those undergoing colorectal surgery. Sub-group analysis including only high-quality studies showed limited gastrointestinal benefits with GDFT. Only a few trials primarily investigated the effect of GDFT on the recovery of bowel function. However, the validity of these results was influenced by a high degree of statistical and clinical heterogeneity. In the randomized controlled trial, GDFT did not reduce the incidence of PPOI when compared to fluid therapy based on traditional principles (21.9% in both groups, p=1.000), even though patients treated with GDFT had a more pronounced and sustained increase of stroke volume and cardiac output during surgery, and received less intravenous fluids. Sub-lingual microcirculation analysis demonstrated that GDFT improved the proportion of perfused vessels (PPV) (p = 0.023), but this effect did not translate into less PPOI and better bowel function. Patients… Advisors/Committee Members: Gabriele Baldini (Supervisor1), Liane S Feldman (Supervisor2).

Subjects/Keywords: Surgery

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Gómez Izquierdo, J. C. E. (2017). Goal directed fluid therapy and gastrointestinal function after abdominal surgery. (Doctoral Dissertation). McGill University. Retrieved from http://digitool.library.mcgill.ca/thesisfile148426.pdf

Chicago Manual of Style (16th Edition):

Gómez Izquierdo, Juan Camilo Ernesto. “Goal directed fluid therapy and gastrointestinal function after abdominal surgery.” 2017. Doctoral Dissertation, McGill University. Accessed February 20, 2020. http://digitool.library.mcgill.ca/thesisfile148426.pdf.

MLA Handbook (7th Edition):

Gómez Izquierdo, Juan Camilo Ernesto. “Goal directed fluid therapy and gastrointestinal function after abdominal surgery.” 2017. Web. 20 Feb 2020.

Vancouver:

Gómez Izquierdo JCE. Goal directed fluid therapy and gastrointestinal function after abdominal surgery. [Internet] [Doctoral dissertation]. McGill University; 2017. [cited 2020 Feb 20]. Available from: http://digitool.library.mcgill.ca/thesisfile148426.pdf.

Council of Science Editors:

Gómez Izquierdo JCE. Goal directed fluid therapy and gastrointestinal function after abdominal surgery. [Doctoral Dissertation]. McGill University; 2017. Available from: http://digitool.library.mcgill.ca/thesisfile148426.pdf

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