A new preoperative ultrasound evaluation for optimal capacity management of emergency surgery patients: a randomized controlled clinical study

Abstract

Abstract Background: Patients undergoing emergency surgery often experience fluid depletion. Therefore, it is critical to use an efficient emergency preoperative blood volume assessment method. Based on current ultrasound assessment, a new method for ultrasound diagnosis and treatment, called Dai's preoperative ultrasound assessment (DPUA), has been developed. Three cardiovascular ultrasound views of DPUA include apical four-chamber, parasternal long-axis, and subxiphoid inferior vena cava views. Data of cardiovascular ultrasound slices correspond to volume conversion and fluid rehydration protocol ultrasound integration algorithm, which can be used to guide volume management in emergency surgery patients. Methods: This trial was a single-center randomized controlled study whose subjects were 60 patients undergoing emergency general anesthesia with no one dropped out. They were divided into experience group and ultrasound group. In experience group, patient volume status was assessed through blood pressure, heart rate, and fluid supplementation for patients based on the personal experience of anesthesiologists. In ultrasound group, the anesthesiologist chose different rehydration solutions through DPUA. Results: The main outcome indicator of this study was the stability of the circulatory blood pressure, which was mainly reflected in the comparison of the average arterial pressure at different times. The difference in the mean arterial pressure at the beginning of surgery was statistically significant (P=0.003**), and blood pressure fluctuation in ultrasound group was smaller than that in experience group, indicating that DPUA maintained better stability of the volume at the beginning of the operation. The experience group used more crystalloids within 30 min of choosing the fluid replacement regimen, and the ultrasound group used more colloids (P=0.036*). Conclusions: Preoperative ultrasound assessment of the DPUA could effectively and accurately assess the patient's cardiac function and volume status, as well as better guide perioperative fluid management. Trial registration: Registration number: ClinicalTrials.gov ID NCT04111783. First registered on 01/10/2019, https://clinicaltrials.gov/.