Abstract
Introduction Optimum perioperative fluid therapy is important to improve the outcome of the surgical patient. This study prospectively compared goal-directed intraoperative fluid therapy with traditional fluid therapy in general surgical patients undergoing open major bowel surgery. Methodology Patients between 20 and 70 years of age, either gender, ASA I and II, and scheduled for elective open major bowel surgery were included in the study. Patients who underwent laparoscopic and other surgeries were excluded. After routine induction of general anaesthesia, the patients were randomised to either the control group (traditional fluid therapy), the FloTrac group (based on stroke volume variation), or the PVI group (based on pleth variability index). Fluid input and output, recovery characteristics, and complications were noted. Results 306 patients, with 102 in each group, were enrolled. Five patients (control (1), FloTrac (2), and PVI (2)) were inoperable and were excluded. Demographic data, ASA PS, anaesthetic technique, duration of surgery, and surgical procedures were comparable. The control group received significantly more crystalloids (3200 ml) than the FloTrac (2000 ml) and PVI groups (1875 ml), whereas infusion of colloids was higher in the FloTrac (400–700 ml) and PVI (200–500 ml) groups than in the control group (0–500 ml). The control group had significantly positive net fluid balance intraoperatively (2500 ml, 9 ml/kg/h) compared to the FloTrac (1515 ml, 5.4 ml/kg/h) and PVI (1420 ml, 6 ml/kg/h) groups. Days to ICU stay, HDU stay, return of bowel movement, oral intake, morbidity, duration of hospital stay, and survival rate were comparable. The total number of complications was not different between the three groups. Anastomotic leaks occurred more often in the Control group than in the others, but the numbers were small. Conclusions Use of goal-directed fluid management, either with FloTrac or pleth variability index results in a lower volume infusion and lower net fluid balance. However, the complication rate is similar to that of traditional fluid therapy. This trial is registered with CTRI/2018/04/013016.
Highlights
Optimum perioperative fluid therapy is important to improve the outcome of the surgical patient. is study prospectively compared goal-directed intraoperative fluid therapy with traditional fluid therapy in general surgical patients undergoing open major bowel surgery
A method that is objective and accurate would help eliminate guesswork involved in fluid therapy currently in these situations. ere is increasing evidence in the literature advocating the use of individualised goal-directed fluid therapy guided by dynamic indicators of fluid responsiveness such as arterial pressure-based stroke volume variation, pulse pressure variation, and systolic pressure variation [8,9,10,11]. e pleth variability index can be obtained from a Masimo pulse oximeter and is totally noninvasive unlike the other parameters
A total of 306 patients who fulfilled the criteria were enrolled in the study. 102 patients were allocated to each group
Summary
Fluid therapy is an integral part of care of patients undergoing major abdominal surgery. Is study was undertaken to prospectively compare goal-directed intraoperative fluid therapy using FloTrac (Vigileo monitor) or pleth variability index (Masimo Radical-7 monitor) with traditional fluid therapy in general surgical patients undergoing open major bowel surgery. Patients in the FloTrac group had a radial arterial line (20 G) secured for continuous monitoring of arterial blood pressure after induction of anaesthesia. E FloTrac sensor was attached to the arterial line and connected to the Vigileo monitor—3rd generation (Edwards Lifesciences, Irvine, California, USA) Once patient data such as age, sex, height, and weight were entered, the system computed stroke volume from the patient’s arterial pressure signal and displayed cardiac index and SVV continuously. HES was given up to a maximum of 20 ml/kg as required beyond which fluid boluses were done using Ringer lactate in both the FloTrac and PVI groups.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
