Goal Directed Fluid Therapy based on Stroke Volume Variation and Oxygen Delivery Index using Electrical Cardiometry in patients undergoing Scoliosis Surgery

Abstract

ABSTRACT Background: The primary outcome was to evaluate whether goal-directed fluid therapy (GDFT) protocol, established on stroke volume variation (SVV) and oxygen delivery index (DO2I) using electrical cardiometry (EC) monitor, would be effective in reducing perioperative packed red blood cells (RBCs) transfusion, whereas the secondary outcome was to compare the effects of GDFT with liberal fluid therapy (LFT) as regards total amount of fluids transfused, perioperative complications, and postoperative length of ICU and total hospital stay. Settings and Design: This study was a prospective randomized controlled clinical trial. Methods: The study was carried out on 48 patients scheduled for scoliosis surgery. Twenty-four patients, whose intraoperative fluid administration was managed with the GDFT protocol, were compared with 24 patients who received a liberal intraoperative fluid therapy. The proposal and raw data were registered on PACTR as PACTR202007901764021. Results: Patients in group II received less units of packed RBCs (P < 0.001) and a lower volume of intraoperative crystalloids (P < 0.001). They had significantly lower serum lactate levels 2 h after induction (P = 0.033), at the end of surgery (P = 0.001) and 2 h postoperatively (P < 0.001) with shorter ICU stay (P < 0.001), total hospital length of stay (P < 0.001), and faster return of bowel function (P = 0.005). Conclusion:: Application of a GDFT protocol, established o SVV and DO2I using EC monitor in patients undergoing scoliosis surgery, can lead to reduced packed RBCs transfusions, reduced total crystalloid volume infusions, less postoperative pulmonary complications, shorter ICU, and total hospital stay with faster return of gastrointestinal function. Abbreviations: GDFT: goal-directed fluid therapy; SVV: stroke volume variation; DO2I: oxygen delivery index; EC: electrical cardiometry; LFT: liberal fluid therapy; CI: cardiac index; RBCs: red blood cells; CO: cardiac output; IVC: inferior vena cava; CVP: central venous pressure; MAP: mean arterial pressure; CaO2: arterial oxygen content; UOP: urine output; ASA: American Society of Anesthesiologist; BMI: body mass index; ROC: receiver operating characteristic; AUC: area under the curve; FFP: fresh frozen plasma