Clinical research of goal-directed fluid management based on the cardiac index/stroke volume index/stroke volume variation in geriatric patients undergoing thoracic lobectomy

Abstract

Objective To evaluate the influence of goal-directed fluid management strategies based on cardiac index/stroke volume index/stroke volume variation (CI/SVI/SVV) in geriatric patients undergoing thoracic lobectomy.Methods Thirty patients undergoing elective lobectomy,age ≥ 65 y,ASA Ⅰ-Ⅱ,were randomly assigned to the S group (CI/SVI/SVV-directed,n=15) and the C group (CVP-directed,n=15).The parameters including heart rate (HR),mean arterial pressure (MAP),arterial oxygen saturation (SpO2),end-tidal carbon dioxide partial pressure (PETCO2),airway pressure (Pmax) and bispectral index (BIS) were recorded.CI/SVI/SVV-directed fluid management strategy and the traditional CVP guided fluid management strategy were compared by clinical outcomes.Results There was no statistically significant difference in general informations between the two groups.No statistically significant difference in HR,MAP,SpO2,PETCO2,Pmax and BIS was found.Fluid intake during operation (1 310±310) ml and positive fluid balance during post-operation period(516±412) ml were lower in the S group compared with the C group (1 820± 459),(757±667) ml (P＜O.05).The stay time in ICU of S group was shorter than C group,while the oxygen index of S group was higher than C group.The incidence of post-operation hypertension was lower in S group (6.67％) than C group (40％) (P＜0.05).Conclusions CI/SVI/SVV-directed geriatric perioperative fluid management strategy is more noninvasive and managable than the traditional CVP guided fluid management.The Individual CI / SVI / SVV-directed fluid management strategy is beneficial to improve postoperative outcome of geriatric patients. Key words: Geriatric patients; Thoracic lobectomy; Arterial pressure-based cardiac output; Goal-directed therapy; Anesthesia; Fluid management; Postoperative outcome