Investigating the effectiveness of an intraoperative decision support guided fluid therapy intervention on postoperative outcome of high-risk patients undergoing high-risk abdominal surgery: protocol for an international multicentre stepped-wedge cluster-randomised implementation trial.

Journal: BJA open
Published Date: Jun 5, 2025

Abstract

BACKGROUND: Inappropriate fluid administration can impact patient outcome. Intraoperative advanced haemodynamic monitoring coupled with a treatment protocol based on stroke volume optimisation can help determine the appropriate timing for fluid boluses. Although recommended by several anaesthesia societies, this strategy is rarely implemented because protocols are complex and compliance is often poor. The Acumen Assisted Fluid Management (AFM) software is a decision support system that uses machine learning to predict fluid responsiveness and individualise fluid therapy. AFM reportedly predicts fluid responsiveness better than clinicians, decreases preload-dependent states, and improves both macro- and microcirculatory variables. The goal of this international multicentre stepped-wedge cluster randomised trial is to test whether implementing AFM during high-risk surgery improves patient outcome.

Authors

  • Sean Coeckelenbergh
    From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France.
  • Amelie Delaporte
    Department of Anesthesiology & Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
  • Damien Rousseleau
    Department of Anesthesiology and Intensive Care Department, Claude Huriez Hospital, Lille University Hospital, Lille, France.
  • Jacques De Montblanc
    Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Le Kremlin Bicêtre, France.
  • Stephanie Roullet
    Department of Anesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France.
  • Joanna Ramadan
    Department of Anesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France.
  • Bernard Cholley
    Department of Anesthesiology, Intensive Care Perioperative Medicine, Hôpital Européen Georges Pompidou, Paris Cité University, Paris, France.
  • Alexandre Stibon
    Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
  • Emmanuel Weiss
    Department of Anesthesiology and Critical Care, Beaujon Hospital, Paris Cité University, Paris, France.
  • Maria-Christina Kassab
    Department of Anesthesiology, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
  • Sylvain Diop
    Department of Anesthesiology, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
  • Elsa Manzi
    Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France.
  • Marco Pustetto
    Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, Grenoble, France.
  • Guillaume Porta Bonette
    Department of Anesthesiology and Perioperative Medicine, Pierre-Paul Riquet Hospital, Toulouse, France.
  • Pierre Gregoire Guinot
    Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Centre, University of Burgundy and Franche-Comté, Dijon, France.
  • Philippe Guerci
    Department of Anesthesiology, Nancy University Hospital, Nancy, France.
  • Domien Vanhonacker
    Department of Anesthesiology, Perioperative and Pain Medicine, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
  • Francois Martin Carrier
    Department of Anesthesiology, Montreal University Hospital, Montreal, QC, Canada.
  • Brenton Alexander
    Department of Anesthesiology & Perioperative Medicine, University of California San Diego, San Diego, CA, USA.
  • Joseph Rinehart
  • David Boldt
    Department of Anesthesiology & Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
  • Tristan Grogan
    Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
  • Maxime Cannesson
    Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
  • Jacques Duranteau
    From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France.
  • Lamiae Grimaldi
    Clinical Research Unit, Paris-Saclay University, Bicêtre Hospital, Le Kremlin Bicêtre, France.
  • Bruno Pereira
    Centre of Biological Engineering, University of Minho, Campus of Gualtar, Braga, Portugal.
  • Alexandre Joosten
    Department of Anesthesiology & Intensive Care, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.

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