Effect Of Goal-Directed Haemodynamic Therapy On Short-Term Postoperative Complications In Patients With Extensive Burns: A Single-Centre Randomised Controlled Trial

Background: To investigate the effect of goal-directed hemodynamic treatment on perfusion and short-term prognosis in patients undergoing early Tangential excision and skin grafting for extensive burns. Methods: Ninety-five patients with extensive burns undergoing early Tangential excision and skin grafting were randomly divided into a standard hemodynamic management group (control group) and a goal-directed therapy group (GDHT group), with the control group guided by conventional parameters and the GDHT group guided by stroke volume (SV) based on Vigileo. The primary outcomes were cardiac complications, pulmonary complications, neurological disease, acute kidney injury, and pain within 7 days postoperatively. Secondary outcomes included microcirculatory perfusion metrics: The central venous-arterial carbon dioxide partial pressure difference (Pcv-aCO2), and blood lactate (Lac). investigators assessing outcomes were blinded to group allocation. Results: : When analysing 47 subjects in the GDHT group and 48 subjects in the control group, fewer patients in the GDHT group had postoperative pulmonary complications [pneumonia (2:9, P=0.027); oxygenation index <300 (3:8, P=0.041)] and controls were more likely to have atrial fibrillation (4:12, P=0.032) Renal and neurological complications did not differ between groups. Pcv-aCO2 and Lac were higher in the Con group after the intervention compared to the control group, and there was no difference between the two groups postoperatively. In this study, Pcv-aCO2 and Lac were Key influencing factors for pulmonary complications within 7 days postoperatively (Beta=0.197, P=0.000; Beta=0.147, P=0.000). Conclusion: SV-guided GDHT improves microcirculatory perfusion and has fewer short-term postoperative complications compared with standard hemodynamic therapy. Trial registration: NCT05221788 (03/02/2022)