The effect of goal-directed fluid therapy in renal transplant surgery on postoperative outcome: A retrospective study

Objective To evaluate the effect of goal-directed fluid therapy on postoperative rehabili-tation in elderly patients undergoing surgery in the prone position. Methods Sixty patients of both sexes, aged 60-75 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective lumbar surgery in the prone position under general anesthesia, were divided into 2 groups(n=30 each)using a random number table: conventional fluid therapy group(group C)and goal-directed fluid therapy group(group G). The CNAP system was used to monitor stroke volume variation and cardiac index continuously in group G. Mean arterial pressure was maintained at 60-110 mmHg, central venous pressure at 6-12 cmH2O and urine volume more than 0.5 ml·kg-1·h-1 using conventional fluid therapy in group C. In group G, goal-directed fluid therapy was performed under the guidance of stroke volume variation, and cardiac index was maintained at 2.5-4.0 L·min-1·m-2.The requirement for crystalloid and colloid solution, total volume of fluid infused, blood loss, urine volume and requirement for vasoactive agents were recorded during operation.After anesthesia induction, at 1 h after turning to the prone position and at the end of operation, blood samples were collected from the left radial artery for blood gas analysis, and the blood lactate concentration was recorded.The volume of drainage within 3 days after operation, perioperative blood transfusion, early postoperative cardiovascular and pulmonary complications, development of oliguria and anuria, emergence time and length of hospital stay were recorded. Results Compared with group C, the requirement for crystalloid solution, total volume of fluid infused, urine volume and requirement for vasoactive agents were significantly decreased during operation, the requirement for colloid solution was increased during operation, the blood lactate concentration was decreased at 1 h after turning to the prone position and at the end of operation, the length of hospital stay was shortened, and the incidence of postoperative cardiovascular and pulmonary complications was decreased in group G(P<0.05). Conclusion Goal-directed fluid therapy can promote postoperative rehabilitation and shows a certain clinical value in elderly patients undergoing surgery in the prone position. Key words: Fluid therapy; Aged; Prone position; Rehabilitation

Objective To investigate the effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing resection of gastrointestinal tumor. Methods A total of 100 elderly patients of both sexes, aged 65-90 yr, of ASA physical status Ⅱ or Ⅲ, scheduled for elective radical operations for stomach, colon or rectal cancers, were included and randomly divided into 2 groups (n=50 each) using a random number table: goal-directed fluid therapy group (group G) and conventional fluid therapy group (group C). HR, mean arterial pressure, central venous pressure, arterial oxygen saturation and partial pressure of end-tidal CO2 were monitored continuously in the two groups.The FloTrac/Vigileo system was used to monitor cardiac output, cardiac index, stroke volume, stroke volume index and stroke volume variation at the same time in group G. In group C, mean arterial pressure was maintained at 60-110 mmHg, and central venous pressure at 6-12 cmH2O.In group G, cardiac index was maintained at 2.5-4.0 L·min-1·m-2, stroke volume variation at 2%-13%, mean arterial pressure at 65-110 mmHg and stroke volume index at 35-47 ml/m2.Crystalloid solution was compound electrolyte solution, and colloid solution was hydroxyethyl starch 130/0.4.The requirement for crystalloid and colloid, total volume of fluid infused, urine volume, and requirement for vasoactive agents were recorded during operation.The time for removal of the endotracheal tube, time when the patients passed the flatus, length of hospital stay after operation, total length of hospital stay, and total medical costs were recorded.The operation-related complications after operation, and development of cadiovascular and pulmonary complications, oliguria, anuria and renal insufficiency during and after operation were recorded. Results Compared with group C, the requirement for crystalloid and colloid, total volume of fluid infused and urine volume were significantly decreased, the requirement for vasoactive agents was increased, the length of hospital stay after operation, total length of hospital stay and time when the patients passed the flatus were shortened, and total medical costs were reduced, and the incidence of operation-related complications after operation, and cadiovascular and pulmonary complications was decreased in group G. Conclusion Goal-directed fluid therapy based on FloTrac/Vigileo system can significantly promote postoperative rehabilitation and shows certain clinical value in elderly patients undergoing resection of gastrointestinal tumor. Key words: Fluid therapy; Aged; Gastrointestinal neoplasms

Optimal fluid management during neurosurgery is controversial. Evidences suggest that goal-directed fluid therapy (GDFT) can improve postoperative outcome. This study aimed to assess the intraoperative use of GDFT on the duration of hospital stay and postoperative complications in patients undergoing craniotomy for large supratentorial tumors. Forty patients of 18-65 years age undergoing large supratentorial tumor surgery were prospectively randomized into two groups. Control-group received fluid regimen based on routine hemodynamic monitoring, whereas patients belonging to GDFT group received fluid based on stroke volume variation (SVV)-guided therapy. A colloid bolus of 250 ml 6% hydroxyl ethyl starch was given, if the SVV was more than 12% in the GDFT group. Hemodynamic parameters, such as blood pressure and heart rate, and dynamic parameters, such as cardiac index, stroke volume index, and SVV, were recorded at different time intervals. The total amount of fluid required was significantly lower in GDFT (P = 0.003) group as compared to the Control group. Intraoperative complications were significantly lower in GDFT group (P = 0.005), but the incidence of tight brain was significantly higher in the control group. The duration of hospital stay (P = 0.07) and incidence of postoperative complications (P = 0.32) were lower in GDFT group. Neurological outcomes at-discharge were similar in both the groups. This study did not show any benefit of GDFT over conventional intraoperative fluid therapy in terms of incidence of postoperative complications, hospital and ICU stay, and Glasgow outcome scores at-discharge in patients undergoing craniotomy for excision of large supratentorial tumors. However, the use of GDFT leads to better perioperative fluid management and brain relaxation scores. CTRI/2016/10/007350.

Background: The intraoperative rehydration technique known as the effect of Goal-Directed Fluid Therapy (GDFT), which is guided by the dynamic monitoring of volume responsiveness, has received a lot of attention recently. According to a meta-analysis by Bene, GDFT can maintain intraoperative hemodynamic stability, which lowers the incidence of postoperative complications and reduces stay at the intensive care unit. Objectives: This study aimed to determine how GDFT affected elderly patients who underwent combined lingual and cervical radical surgery after an operation for postoperative cognitive dysfunction (POCD). Methods: This interventional study was conducted between December 2021 and December 2022 in a medical center affiliated with Fujian Medical University on people undergoing radical neck and tongue surgery for tongue cancer. The samples (n=36) were selected using an availability sampling method and randomly divided into conventional fluid therapy (the Non-GDFT, n=18) and GDFT (n=18) groups. The Non-GDFT group was hydrated normally during anesthesia. A continuous infusion of 8 mL/(kg/h) of compounded sodium chloride was administered to the GDFT group to maintain basal hydration volume during the operation. Before and following surgery, Montreal Cognitive Assessment Scale scores were completed, arterial blood lactate values and bilateral cerebral oxygen saturation levels were measured at various times following the stabilization of anesthesia, and the levels of interleukin 6 (IL-6) and S100 protein in venous blood were calculated. Results: The Non-GDFT group had a higher incidence of POCD than the GDFT group, the GDFT group had significantly lower levels of IL-6 and S100 than the Non-GDFT group, the GDFT group had significantly lower levels of serum lactate than the Non-GDFT group. The GDFT group experienced significantly lower rates of intraoperative hypotensive and intraoperative low rSO2 events than the Non-GDFT group, and this difference was statistically significant (P&lt;0.05). Conclusion: Assuring the balance of cerebral oxygen supply and demand, lowering the production of inflammatory mediators, and successfully reducing the incidence of POCD are all possible benefits of GDFT.

Intraoperative fluid therapy maintains normovolemia, normal tissue perfusion, normal metabolic function, normal electrolytes, and acid-base status. Plethysmographic variability index has been shown to predict fluid responsiveness but its role in guiding intraoperative fluid therapy is still elusive. The aim of the present study was to compare intraoperative goal-directed fluid therapy based on plethysmographic variability index with liberal fluid therapy in term neonates undergoing abdominal surgeries. A prospective randomized controlled study was conducted in a tertiary care centre, over a period of 18 months. A total of 30 neonates completed the study out of 132 neonates screened. Neonates with tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease, respiratory disorders, creatinine clearance <90 mL/min and who were hemodynamically unstable were excluded. Neonates were randomized to goal-directed fluid therapy group where the plethysmographic variability index was targeted at <18 or liberal fluid therapy group. Primary outcome was comparison of total amount of fluid infused intraoperatively in both the groups. Secondary outcomes included intraoperative and postoperative arterial blood gas parameters, biochemical parameters, use of vasopressors, number of fluid boluses, complications and duration of hospital stay. There was no significant difference in total intraoperative fluid infused [90 (84-117.5 mL) in goal-directed fluid therapy and 105 (85.5-144.5 mL) in liberal fluid therapy group (p = .406)], median difference (95% CI) -15 (-49.1 to 19.1). There was a decrease in serum lactate levels in both groups from preoperative to postoperative 24 h. The amount of fluid infused before dopamine administration was significantly higher in liberal fluid therapy group (58 [50.25-65 mL]) compared to goal-directed fluid therapy group (36 [22-44 mL], p = .008), median difference (95% CI) -22 (-46 to 2). In postoperative period, the total amount of fluid intake over 24 h was comparable in two groups (222 [204-253 mL] in goal-directed fluid therapy group and 224 [179.5-289.5 mL] in liberal fluid therapy group, p = .917) median difference (95% CI) cutoff -2 (-65.3 to 61.2). Intraoperative plethysmographic variability index-guided goal-directed fluid therapy was comparable to liberal fluid therapy in terms of total volume of fluid infused in neonates during perioperative period. More randomized controlled trials with higher sample size are required. Central Trial Registry of India (CTRI/2020/02/023561).

Objective To evaluate the effect of goal-directed fluid therapy (GDFT) on postoperative cognitive function in the patients undergoing intracranial tumor resection. Methods One hundred patients of both sexes, aged 45-64 yr, weighing 50-70 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective cerebral glioma or meningioma resection, were randomly divided into 2 groups(n=50 each) using a random number table: GDFT group (group G) and conventional fluid therapy group (group C). The mean arterial pressure was maintained at 65-110 mmHg, urine volume >0.5 ml·kg-1·h-1, and central venous pressure at 8-12 cmH2O in group C. In group G, GDFT was performed using FloTrac/Vigileo system, and the cardiac index was maintained at 2.5-4.0 L·min-1·m-2, stroke volume variation≤13%, mean arterial pressure at 65-110 mmHg, and stroke volume index at 35-47 ml/m2.The requirement for crystalloid and colloid, urine volume, blood loss, and requirement for vasoactive agents were recorded during operation.Before induction of anesthesia (baseline), when the dura of brain was opened, at the end of tumor removal, at the end of operation, and at 24 h after operation (T0-4), venous blood samples were taken to determine the concentrations of serum neuron-specific enolase (NSE) and S100β protein by enzyme-linked immunosorbent assay.The patient′s cognitive function was assessed using Mini-Mental State Examination at T0 and 7 days after operation (T5). Results Compared with the baseline value at T0, the serum NSE and S100β protein concentrations were significantly increased at T2-4 in the two groups (P 0.05). Conclusion GDFT based on FloTrac/Vililgeo system can reduce the damage to brains after operation, but it has no significant effect on postoperative cognitive function in the patients undergoing intracranial tumor resection. Key words: Fluid therapy; Cognition disorders; Neurosurgical procedures

Goal-directed fluid therapy versus conventional fluid therapy in colorectal surgery: A meta analysis of randomized controlled trials

BackgroundIntraoperative goal-directed fluid therapy (GDFT) has been reported to reduce postoperative complications of patients undergoing major abdominal surgery. The clinical benefits of pleth variability index (PVI)-directed fluid management for gastrointestinal (GI) surgical patients remain unclear. Therefore, this study aimed to evaluate the impact of PVI-directed GDFT on GI surgical outcomes in elderly patients.MethodsThis randomised controlled trial was conducted in two university teaching hospitals from November 2017 to December 2020. In total, 220 older adults undergoing GI surgery were randomised to the GDFT or conventional fluid therapy (CFT) group (n = 110 each). The primary outcome was a composite of complications within 30 postoperative days. The secondary outcomes were cardiopulmonary complications, time to first flatus, postoperative nausea and vomiting, and postoperative length of stay.ResultsThe total volumes of fluid administered were less in the GDFT group than in the CFT group (2.075 L versus [vs.] 2.5 L, P = 0.008). In intention-to-treat analysis, there was no difference in overall complications between the CFT group (41.3%) and GDFT group (43.0%) (odds ratio [OR] = 0.935; 95% confidence interval [CI], 0.541–1.615; P = 0.809). The proportion of cardiopulmonary complications was higher in the CFT group than in the GDFT group (19.2% vs. 8.4%; OR = 2.593, 95% CI, 1.120–5.999; P = 0.022). No other differences were identified between the two groups.ConclusionsAmong elderly patients undergoing GI surgery, intraoperative GDFT based on the simple and non-invasive PVI did not reduce the occurrence of composite postoperative complications but was associated with a lower cardiopulmonary complication rate than usual fluid management.Trial registrationThis trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-17012220) on 1 August 2017.

The aim of this study is to evaluate the intra/perioperative fluid management and early postoperative outcomes of patients who underwent radical cystectomy with Enhanced Recovery After Surgery protocol, using goal-directed fluid therapy compared to conventional fluid therapy. This cohort study included patients who underwent open RC for urothelial bladder carcinoma with intent to cure and Enhanced Recovery After Surgery protocol between May 2012 and August 2019. Patients who had palliative or salvage cystectomy and/or adjunct procedures, as well as those with missing detailed perioperative data were excluded. Data were compared between patients who received goal-directed fluid therapy using stroke volume variation by FloTrac™/Vigileo system (n = 119) and conventional fluid therapy based on the anesthesiologist discretion (n = 192). Primary outcome variable was 90-day complications and secondary outcome measures included in-hospital GFR trend, length of stay, and 90-day readmission. The goal-directed fluid therapy group received less total and net intra/perioperative fluid, yet early postoperative glomerular filtration rate trends were similar between both groups (p = 0.7). Estimated blood loss, blood transfusion, index hospital stay, 90-day complication and readmission rates were also comparable between the two groups. Multivariable logistic regression showed no significant association between perioperative fluid management method and 90-day complication rate (OR 1.4, 95% CI 0.8-2.4, p = 0.2). Stroke volume variation guided goal-directed fluid therapy is safe in radical cystectomy without compromising the renal function. It is associated with less intra- and perioperative fluid infusion; however, no association with hospital stay, 90-day complication or readmission rates were noted.

BackgroundPostoperative complications have become the main cause of prolonged hospitalization and reduced postoperative survival rate among surgical patients. Goal-directed fluid therapy (GDFT) has been reported to reduce the incidence of postoperative complications and mortality, shorten the hospital stay, and improve the outcome in major abdominal surgery patients. However, the benefit of GDFT in patients undergoing head and neck cancer surgery remains controversial. The purpose of this study is to evaluate whether GDFT can reduce the occurrence of serious postoperative complications and shorten the postoperative hospital stay, compared with standard conventional fluid therapy in patients undergoing head and neck cancer surgery.MethodsA total of 340 adult patients who scheduled for head and neck cancer surgery will be enrolled in this prospective, single-center, partly blinded, randomized controlled trial. Both groups will receive standard general anesthesia. Participants will be randomly assigned to GDFT group (group G) or conventional fluid therapy group (group C). Patients in group G will receive GDFT protocol associated with the stroke volume variation (SVV) ≤ 12% and the cardiac index (CI) was controlled at a minimum of 2.5 L/min/m2, whereas patients in group C underwent conventional fluid therapy based on mean arterial pressure (MAP) and urine output. The primary outcome is serious postoperative complications occurred within 30 days after surgery.DiscussionThis study will better demonstrate whether GDFT has a positive effect on postoperative outcomes in head and neck cancer patients. Results of the study will provide evidence for selecting appropriate intraoperative fluid management methods in such patients.Trial registrationClinicalTrials.gov NCT06468852. Registered on June 21, 2024Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09152-7.

BackgroundTo investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection.MethodsPatients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared.ResultsTwo-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048).ConclusionsUnder ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group.Trial registrationRegistered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.

Goal-directed fluid therapy (GDFT) has conflicting evidence regarding outcomes in neurosurgical patients. This meta-analysis aimed to compare the effect of GDFT and conventional fluid therapy on various perioperative outcomes in patients undergoing neurosurgical procedures. A comprehensive literature search was conducted using PubMed, EMBASE, Scopus, ProQuest, Web of Science, EBSCOhost, Cochrane and preprint servers. The search was conducted up until 16 October 2023, following PROSPERO registration. The search strategy included terms related to GDFT, neurosurgery and perioperative outcomes. Only randomised controlled trials involving adult humans and comparing GDFT with standard/liberal/traditional/restricted fluid therapy were included. The studies were evaluated for risk of bias (RoB), and pooled estimates of the outcomes were measured in terms of risk ratio (RR) and mean difference (MD). No statistically significant difference was observed in neurological outcomes between GDFT and conventional fluid therapy [RR with 95% confidence interval (CI) was 1.10 (0.69, 1.75), two studies, 90 patients, low certainty of evidence using GRADEpro]. GDFT reduced postoperative complications [RR = 0.67 (0.54, 0.82), six studies, 392 participants] and intensive care unit (ICU) and hospital stay [MD (95% CI) were -1.65 (-3.02, -0.28) and -0.94 (-1.47, -0.42), respectively] with high certainty of evidence. The pulmonary complications were significantly lower in the GDFT group [RR (95% CI) = 0.55 (0.38, 0.79), seven studies, 442 patients, high certainty of evidence]. Other outcomes, including total intraoperative fluids administered and blood loss, were comparable in GDFT and conventional therapy groups [MD (95% CI) were -303.87 (-912.56, 304.82) and -14.79 (-49.05, 19.46), respectively]. The perioperative GDFT did not influence the neurological outcome. The postoperative complications and hospital and ICU stay were significantly reduced in the GDFT group.

To investigate the impact of goal-directed fluid therapy (GDFT) on postoperative cognitive dysfunction (POCD) in elderly patients with colorectal cancer, we conducted a randomized controlled trial. Eighty elderly patients who underwent elective laparoscopic radical resection of colorectal cancer were randomly assigned to either the GDFT group or the conventional fluid therapy group. The primary outcome was the incidence of POCD during the initial 7 postoperative days, while secondary outcomes included inflammatory marker levels such as interleukin-6 (IL-6) and S100β protein, hemodynamics, level of lactic acid, postoperative functional recovery, and complications. Among 88 randomized patients, 80 were evaluable for the primary outcome. The incidence of POCD was significantly lower in the GDFT group (15.0%) compared to the conventional fluid therapy group (30.0%), with the highest occurrence observed on day 3 postoperatively in both groups (P < 0.05). IL-6 and S100β concentrations were consistently lower in the GDFT group than in the conventional fluid therapy group at the corresponding time points (P < 0.05). The GDFT group exhibited more stable perioperative hemodynamics and lower lactate levels (P < 0.05). Moreover, patients in the GDFT group exhibited better postoperative functional recovery indicators and a lower incidence of postoperative complications (P < 0.05). In summary, GDFT appears to reduce the incidence of early POCD, accelerate postoperative recovery, and enhance overall prognosis.

Intraoperative fluid balance significantly affects patients' outcomes. Goal-directed fluid therapy (GDFT) has reduced the incidence of major postoperative complications by 20% for 30 days after open abdominal surgery. Little is known about GDFT during laparoscopic surgery. We investigated whether GDFT affects the postoperative outcomes in laparoscopic hepatobiliary or pancreatic surgery compared with conventional fluid management. This interventional comparative study with a historical control group was performed in the tertiary care center. Patients were allocated to one of two groups. The GDFT (n = 147) was recruited prospectively and the conventional group (n = 228) retrospectively. In the GDFT group, fluid management was guided by the stroke volume (SV) and cardiac index (CI), whereas it had been performed based on vital signs in the conventional group. Propensity score (PS) matching was performed to reduce selection bias (n = 147 in each group). Postoperative complications were evaluated as primary outcome measures. The amount of crystalloid used during surgery was less in the GDFT group than in the conventional group (5.1 ± 1.1 vs 6.3 ± 1.8 ml/kg/h, respectively; P <0.001), whereas the amount of colloid was comparable between the two groups. The overall proportion of patients who experienced any adverse events was 57.8% in the GDFT group and 70.1% in the conventional group (P = 0.038), of which the occurrence of pleural effusion was significantly lower in the GDFT group than in the conventional group (9.5% vs. 19.7%; P = 0.024). During the postoperative period, the proportion of patients admitted to the intensive care unit (ICU) was lower in the GDFT group than that in the conventional group after PS matching (4.1% vs 10.2%; P = 0.049). GDFT based on SV and CI resulted in a lower net fluid balance than conventional fluid therapy. The overall complication rate in laparoscopic hepatobiliary or pancreatic surgery decreased after GDFT, and the frequency of pleural effusion was the most affected.

Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.