Goal-directed fluid therapy versus restrictive fluid therapy: A cardiomerty study during one-lung ventilation in patients undergoing thoracic surgery

Abstract

ABSTRACT Background Fluid management during thoracic anaesthesia is a challenge for the anaesthesiologists. The “safe zone” between volume overload (pulmonary oedema risk) and hypovolemia (renal failure risk) remains to be narrow and hard to determine. Purpose The aim of the present study was to assess goal-directed fluid therapy using cardiometry versus restrictive fluid therapy during one-lung ventilation in patients planned for having thoracic surgery. Methods After receiving the Ethics Committee approval and taking an informed written consent, a prospective randomized study was conducted. Fifty adult patients of both genders were scheduled for thoracic surgery with one lung ventilation. Patients were randomly categorized using closed envelope technique into two equal groups (25 patients each). Group I: a number of 25 patients underwent thoracic surgery and were managed with goal directed fluid therapy using intraoperative cardiometry. Group II: a number of 25 patients underwent thoracic surgery and were managed with intraoperative restrictive fluid therapy. Results There was a significantly increased serum lactate level, serum creatinine with decreased urine output in restrictive therapy group (RT) by the end of the surgery, immediately postoperative and 6 h postoperative (p value of <0.001). The restrictive hypoxic index values were much higher than the goal directed group values, yet, both were of normal range and no patient suffered of lung injury. A significant increase in serum neutrophil gelatinase-associated lipocalin (Ngal) in the restrictive therapy group compared to the goal directed therapy group. (p value of <0.001). Conclusion From these results, we concluded that patients undergoing thoracic surgery are preferably to be maintained over goal directed therapy protocol using electrical cardiometry. Fluid restriction is better to be individualized and aided by new technologies based on beat-to-beat variations.