Effects of intraoperative goal-directed fluid therapy on postoperative outcomes in patients undergoing thoracoscopic lobectomy: a comparison with restrictive fluid therapy

Abstract

Objective To investigate the effects of different fluid therapies on postoperative outcomes in patients undergoing thoracoscopic lobectomy and to evaluate the advantages of intraoperative goal-directed fluid therapy when compared with restrictive fluid therapy. Methods Fifty-four patients, aged 18-64 yr, with body mass index of 18.5-24.9 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective thoracoscopic lobectomy under general anesthesia, were divided into goal-directed fluid therapy group(group G)and restrictive fluid therapy group(group R)using a random number table method, with 27 patients in each group.In group G, fluid management was guided by an oesophageal Doppler monitoring, Ringer′s solution was continuously infused at a rate of 4 ml·kg-1·h-1, with corrected flow time(FTc)≥350 ms and change in stroke volume(SV)<10% of the pre-rehydration level as the goal.In group R, restrictive fluid management was performed, and blood loss was replaced with hydroxyethyl starch 130/0.4 at a 1∶1 ratio.Compound sodium chloride injection was continuously infused at a rate of 4 ml·kg-1·h-1 until the end of surgery in both groups.Mean arterial pressure, heart rate, SpO2, FTc, SV and cardiac index were recorded at 5 min before intubation, immediately after lateral position, at the start of one-lung ventilation, at the end of one-lung ventilation and at the end of surgery.The amount of fluid intake and output during surgery was recorded.The complications on 1st, 3rd, 5th and 8th days after surgery were evaluated using POMS scale.The length of hospital stay, admission to intensive care unit and in-hospital death were also recorded. Results Compared with group R, FTc, SV and cardiac index were significantly increased at the end of one-lung ventilation and at the end of surgery in group G(P 0.05). No patients were admitted to intensive care unit after surgery, and no in-hospital death occurred in two groups. Conclusion GDFT and restrictive fluid therapy applied during surgery produce similar postoperative outcomes in patients undergoing thoracoscopic lobectomy. Key words: Fluid therapy; Lobectomy; Postoperative complications; Recovery