Effect Of Goal-directed Fluid Therapy Research Articles

A systematic review and meta-analysis on the effect of goal-directed fluid therapy on postoperative outcomes in renal transplantation surgeries

Introduction: This systematic review and meta-analysis investigated the impact of intraoperative goal-directed therapy (GDT) compared with conventional fluid therapy on postoperative outcomes in renal transplantation recipients, addressing this gap in current literature. Method: A systematic search of patients aged ≥18 years who have undergone single-organ primary renal transplantations up to June 2022 in PubMed, Embase, Scopus and CINAHL Plus was performed. Primary outcome examined was postoperative renal function. Secondary outcomes assessed were mean arterial pressure at graft reperfusion, intraoperative fluid volume and other postoperative complications. Heterogeneity was tested using I² test. The study protocol was registered on PROSPERO. Results: A total of 2459 studies were identified. Seven eligible studies on 607 patients were included. Subgroup assessments revealed potential renal protective benefits of GDT, with patients receiving cadaveric grafts showing lower serum creatinine on postoperative days 1 and 3, and patients monitored with arterial waveform analysis devices experiencing lower incidences of postoperative haemodialysis. Overall analysis found GDT resulted in lower incidence of tissue oedema (risk ratio [RR] 0.34, 95% CI 0.15–0.78, P=0.01) and respiratory complications (RR 0.39, 95% CI 0.17–0.90, P=0.03). However, quality of data was deemed low given inclusion of non-randomised studies, presence of heterogeneities and inconsistencies in defining outcomes measures. Conclusion: While no definitive conclusions can be ascertained given current limitations, this review highlights potential benefits of using GDT in renal transplantation recipients. It prompts the need for further standardised studies to address limitations discussed in this review.

The effects of perioperative goal-directed therapy on acute kidney injury after cardiac surgery in the early period

Background: This study aims to investigate the effects of goaldirected fluid therapy on the development of acute kidney injury in the perioperative period in patients undergoing cardiopulmonary bypass. Methods: Between November 2019 and May 2021, a total of 60 patients (46 males, 14 females; mean age: 62.5±9.6 years; range, 44 to 76 years) who were scheduled for elective coronary artery bypass grafting or valve surgery under cardiopulmonary bypass were included in the study. The patients were divided into two groups as the study group (Group S, n=30) and control group (Group C, n=30). The patients in Group C were treated with standard therapy, while the patients in Group S were treated with goal-directed fluid therapy. The Kidney Disease: Improving Global Outcomes (KDIGO) classification and renal biomarkers were used for the evaluation of acute kidney injury. Results: Acute kidney injury rates were similar in both groups (30%). Postoperative fluid requirement, intra-, and postoperative erythrocyte suspension requirements were significantly lower in Group S than Group C (p=0.002, p=0.02, and p=0.002, respectively). Cystatin-C was lower in Group S (p<0.002). The kidney injury molecule-1, glomerular filtration rate, and creatinine levels were similar in both groups. The length of hospital stay was longer in Group C than Group S (p<0.001). Conclusion: Although goal-directed fluid therapy does not change the incidence of acute kidney injury in patients undergoing cardiac surgery, it can significantly decrease Cystatin-C levels. Goal-directed fluid therapy can also decrease fluid and erythrocyte requirements with shorter length of hospital stay.

Effect of goal-directed fluid therapy based on both stroke volume variation and delta stroke volume on the incidence of composite postoperative complications among individuals undergoing meningioma resection.

Effect of goal-directed fluid therapy based on both stroke volume variation and delta stroke volume on the incidence of composite postoperative complications among individuals undergoing meningioma resection.

Effect of Goal-directed Fluid Therapy on Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Combined Lingual and Cervical Radical Surgery

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<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.

Effect of goal-directed fluid therapy based on plasma colloid osmotic pressure on the postoperative pulmonary complications of older patients undergoing major abdominal surgery

BackgroundAs an important component of accelerated rehabilitation surgery, goal-directed fluid therapy (GDT) is one of the optimized fluid therapy strategies and is closely related to perioperative complications and mortality. This article aimed to study the effect of combining plasma colloid osmotic pressure (COP) with stroke volume variation (SVV) as a target for intraoperative GDT for postoperative pulmonary complications in older patients undergoing major abdominal surgery.MethodsIn this study, older patients (n = 100) undergoing radical resection of gastroenteric tumors were randomized to three groups: Group C (n1 = 31) received a conventional infusion regimen, Group S1 (n2 = 34) received GDT based on SVV, and Group S2 (n3 = 35) received GDT based on SVV and COP. The results were recorded, including the lung injury score (LIS); PaO2/FiO2 ratio; lactic acid value at the times of beginning (T0) and 1 h (T1), 2 h (T2), and 3 h (T3) after liquid infusion in the operation room; the total liquid infusion volume; infusion volumes of crystalline and colloidal liquids; urine production rate; pulmonary complications 7 days after surgery; and the severity grading of postoperative pulmonary complications.ResultsThe patients in the S2 group had fewer postoperative pulmonary complications than those in the C group (P < 0.05) and the proportion of pulmonary complications of grade 1 and higher than grade 2 in S2 group was significantly lower than that in C group (P <0.05); the patients in the S2 group had a higher PaO2/FiO2 ratio than those in the C group (P < 0.05), lower LIS than those in the S1 and C groups (P < 0.05), less total liquid infusion than those in the C group (P < 0.05), and more colloidal fluid infusion than those in the S1 and C groups (P < 0.05).ConclusionThe findings of our study show that intraoperative GDT based on COP and SVV can reduce the incidence of pulmonary complications and conducive to shortening the hospital stay in older patients after gastrointestinal surgery.Trial registrationChinese Clinical Trial. no. ChiCTR2100045671. Registry at www.chictr.org.cn on April 20, 2021.

Effect of goal-directed fluid therapy on renal function in critically ill patients: a systematic review and meta-analysis

Objective To evaluate whether goal-directed fluid therapy (GDFT) reduces the risk of renal injury in critical illness. Methods MEDLINE via PubMed, EMBASE, CENTRAL and CBM was searched from inception to 13 March 2022, for studies comparing the effect of GDFT with usual care on renal function in critically ill patients. GDFT was defined as a protocolized intervention based on hemodynamic and/or oxygen delivery parameters. A fixed or random effects model was applied to calculate the pooled odds ratio (OR) based on heterogeneity through the included studies. Results A total of 28 studies with 9,019 patients were included. The pooled data showed that compared with usual care, GDFT reduced the incidence of acute kidney injury (AKI) in critical illness (OR 0.62, 95% confidence interval (CI) 0.47 to 0.80, p< 0.001). Sensitivity analysis with only low risk of bias studies showed the same result. Subgroup analyses found that GDFT was associated with a lower AKI incidence in both postoperative and medical patients. The reduction was significant in GDFT aimed at dynamic indicators. However, no significant difference was found between groups in RRT support (OR 0.88, 95% CI 0.74 to 1.05, p= 0.17). GDFT tended to increase fluid administration within the first 6 h, decrease fluid administration after 24 h, and was associated with more vasopressor requirements. Conclusions This meta-analysis suggests that GDFT aimed at dynamic indicators may be an effective way to prevent AKI in critical illness. This may indicate a benefit from early adequate fluid resuscitation and the combined effect of vasopressors.

Effect of Goal-directed Fluid Therapy on the Shedding of the Glycocalyx Layer in Retroperitoneal Tumour Resection.

To evaluate the effects of different stroke volume variation (SVV) targets on endothelial glycocalyx (EG) shedding. Randomised controlled trial. Department of Anaesthesiology, Peking University International Hospital, Beijing, China, from February to June 2018. Patients undergoing elective retroperitoneal tumour resection were assigned to one of two groups. SVV 9% group (n=40), who received a more traditional (liberal) fluid therapy with SVV ≤9%; and the SVV 14% group (n=40), received restrictive fluid therapy with SVV ≤14%. Patients' serum concentrations of syndecan-1 (SDC-1), interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were measured at the time that patients entered the operating theatre; at 1- and 4-hours following initiation of the surgery; and at 24- and 72-hours post-surgery. Postoperative complications, and one-year survival rates were also noted. Perioperative serum SDC-1, IL-6 and TNF-α concentrations were significantly elevated in both groups, which were more pronounced in SVV 9% (p = 0.028, <0.001, and <0.001 respectively). A positive correlation was observed between SDC-1 and TNF-α, L-6, and infusion volume, respectively. Postoperative complications, including fever and blood transfusion, were more aggravated in SVV 9% than those in SVV 14% (80% vs. 59%, and 45% vs. 23.1%, both p <0.05). However, no significant difference in the one-year survival rate was observed. Using SVV 14% as a target for guiding fluid therapy in elective retroperitoneal tumour resection was associated with reduced perioperative glycocalyx shedding, ameliorated inflammatory response, and reduced postoperative complications. Key Words: Randomised controlled trial, Retroperitoneal neoplasms, Glycocalyx, Tumour necrosis factor-alpha, Interleukin-6, Fluid therapy, Stroke volume.

The Effect of Goal-Directed Fluid Therapy versus Standard Fluid Therapy on the Cuff Leak Gradient in Patients Undergoing Complex Spine Surgery in Prone Position.

Objective  Cuff leak test is an effective and established maneuver to predict airway edema. Standard fluid therapy (SFT) based on conventional monitoring is often associated with postoperative airway edema after complex spine surgeries. We conducted this prospective randomized controlled study to compare the effect of SFT versus goal-directed fluid therapy (GDFT) on the cuff leak gradient (CLG) in patients undergoing complex spine surgery in prone position. Our secondary objectives were to compare the effect of SFT and GDFT on sore throat, hoarseness, and length of intensive care unit (ICU) and hospital stay. Materials and Methods  Thirty consecutive American Society of Anesthesiologists physical status I and II patients (18–60 years), of either sex, scheduled for spine surgery in prone position with expected duration of surgery more than 5 hours were included. The patients were randomized into two groups of 15 each. Group S patients ( n  = 15) served as control group and received SFT intraoperatively, while patients in group G ( n  = 15) received GDFT. Standard anesthetic protocol was followed in both the groups. The CLG was defined as the difference between the cuff leak volume (CLV) after intubation (CLV AI ) and before extubation (CLV BE ). Statistical Analysis and Results  CLG was significantly less in group G (group S, 137.12 mL; group G, 65.52 mL; p -value <0.001). Intravenous fluids, blood loss, and postoperative sore throat were comparatively lesser in group G, though not statistically significant. Postoperative hoarseness was significantly lower in group G ( p -value = 0.003). Duration of ICU stay in group G (19.43 hours) was significantly lower ( p -value = 0.009) than group S (24.64 hours), but length of hospital stay was comparable. Conclusion  GDFT significantly reduces airway edema and consequently reduces CLG as compared with SFT in patients undergoing complex spine surgery in prone position. Postoperatively, it also reduces sore throat, hoarseness of voice, and duration of ICU stay.

Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial.

Background Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation. Method In total, 71 consecutive full-term pregnant women were randomly divided into a control group (n = 34) and a GDFT group (n = 37). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles. Result Women in the GDFT group received more fluid than did those in the control group (1132 ± 108 vs. 1247 ± 202 mL; p = 0.0044), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864) and norepinephrine dose (12.5 ± 10.6 vs. 15.1 ± 12.8 mcg, respectively; p = 0.3512) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups. Conclusion ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.

Effect of Goal-Directed Fluid Therapy on Lung Function, Cognitive Function and Inflammatory Response in Patients Undergoing Radical Esophageal Cancer Surgery under One-Lung Ventilation

Objective: To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. Methods: Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group (GDFT therapy) and control group (conventional liquid therapy). The changes in patients’ pulmonary function, cognitive function and inflammatory response were evaluated. Results: Both alveolar-arterial oxygen partial pressure difference [P(A-a)O2] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T2) and decreased at one-lung ventilation for 60 minutes (T3), and after surgery (T4) in the two groups, and the GDFT group was lower than the control group (P 0.05); theoxygenation index (OI) of the two groups decreased at T2, T3, and T4 compared with that at T1 (before one-lung ventilation), and the GDFT group was higher than the control group (P 0.05). At T4 and T5, the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P 0.05); the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P 0.05). Conclusion: GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body’s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.

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

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

Effect of goal-directed fluid therapy on postoperative intestinal function recovery in the aged patients with rectal cancer

Objective To investigate the effect of intraoperative routine fluid therapy and goal-directed fluid therapy(GDFT) by FloTrac/Vigileo monitoring system on the recovery of intestinal function in aged patients with rectal cancer. Methods Sixty ASAⅠ~Ⅲ patients undergoing laparoscopic anterior resection of rectal cancer(Dixon operation), who were treated in the Third People's Hospital of Datong from August 2018 to May 2019 were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.Group C received routine intraoperative fluid administration, and the total rate of fluid=deficit+ maintenance administration+ loss+ third space losses.Group G fluid therapy goal: cardiac index (CI) 2.5~4.0 L·min-1·(m2)-1, stroke volume variability (SVV) 13%, rapidly infused sodium lactate Ringer's injection 3 mL/kg(within 10 min via an infusion pump); if CI<2.5 L·min-1·(m2)-1, SVV<13%, infused dobutamine; if MAP<65 mmHg, CI≥2.5 L·min-1·(m2)-1, infused norepinephrine.Two groups were continously infused sodium lactate Ringer's injection 3 mL·kg-1·h-1.Equivalent volume 6% hetastarch was infused to supplement the blood loss.During the operation, Hb<80 g/L and red blood cells were transfused when bleeding continued.The total fluid intake, bleeding volume, urine volume, postoperative hospital stay days, postoperative intestinal function recovery(postoperative flatus time and eating time), the incidence of postoperative intestinal complications(postoperative inflammatory bowel obstruction, anastomotic leakage and anastomotic bleeding) were recorded.Intestinal fatty aid binding protein (iFABP) was measured at T0(before the induction), T1(at the end of surgery), T2(2 h after surgery), T3(24 h after surgery) by using ELISA kits. Results The intraoperative fluid intake was (2 051±466)mL in group C, and (1 811±413)mL in group G, there was statistically significant difference between the two groups(t=2.111, P=0.039). The postoperative exhaust time and hospitalization days in group G were 28.6(23.3, 32.1)h and 10.2(9.9, 12.1)d, respecticely, which were shorter than those in group C [32.6(27.1, 40.9)h and 11.6(10.7, 12.2)d] (Z=2.321, P=0.020, Z=2.435, P=0.015). The incidence of postoperative complications was 13%(4/30) in group C, and 10%(3/30) in group G, there was no statistically significant difference(P>0.05). The iFABP of group C at T1 and T2 after operation was significantly higher than those of group G(t=2.445, 3.098, P=0.018, 0.003). Conclusion GDFT can reduce intraoperative crystalloid infusion, promote early intestinal function recovery in elderly patients with rectal cancer, and reduce perioperative intestinal mucosal ischemic injury. Key words: Rectal neoplasms; Fluid therapy; Cardiac index; Stroke volume; Intestinal fatty aid binding protein; Intestinal mucosal; Postoperative complications; Aged

Effects of perioperative goal-directed fluid therapy combined with the application of alpha-1 adrenergic agonists on postoperative outcomes: a systematic review and meta-analysis

BackgroundPast studies have demonstrated that goal-directed fluid therapy (GDFT) may be more marginal than previously believed. However, beneficial effects of alpha-1 adrenergic agonists combined with appropriate fluid administration is getting more and more attention. This study aimed to systematically review the effects of goal-directed fluid therapy (GDFT) combined with the application of alpha-1 adrenergic agonists on postoperative outcomes following noncardiac surgery.MethodsThis meta-analysis included randomized controlled trials (RCTs) on GDFT combined with the application of alpha-1 adrenergic agonists in patients undergoing noncardiac surgery. The primary outcomes included the postoperative mortality rate and length of hospital stay (LOS). The secondary outcome indexes were the incidence of postoperative complications and recovery of postoperative gastrointestinal (GI) function. The traditional pairwise meta-analysis was conducted to compare the effect of fluid therapy. The quality of included RCTs was evaluated according to the Cochrane Collaboration’s risk-of-bias tool. Also, the publication bias was detected using funnel plots, Egger’s regression test, and Begg’s adjusted rank correlation test. The meta-analysis was conducted using the RevMan 5.3 and Stata 14.0 software.ResultsThirty-two eligible RCTs were included in this meta-analysis. Perioperative GDFT combined with the application of alpha-1 adrenergic agonists was associated with a significant reduction in LOS (P = 0.002; I2 = 69%), and overall complication rates (P = 0.04; I2 = 41%). It facilitated gastrointestinal function recovery, as demonstrated by shortening the time to first flatus by 6.30 h (P < 0.00001; I2 = 91%) and the time to toleration of solid food by 1.69 days (P < 0.00001; I2 = 0%). Additionally, there was no significant reduction in short-term mortality in the GDFT combined with alpha-1 adrenergic agonists group (P = 0.05; I2 = 0%).ConclusionThis systematic review of available evidence suggested that the use of perioperative GDFT combined with alpha-1 adrenergic agonists might facilitate recovery in patients undergoing noncardiac surgery.

Effect of goal-directed fluid therapy guided by different goals on endothelial glycocalyx in patients undergoing high-risk abdominal surgery: a prospective randomized controlled clinical study

Objective To evaluate the effect of goal-directed fluid therapy (GDFT) guided by different goals on endothelial glycocalyx, inflammatory cytokines and postoperative complications in patients undergoing high-risk abdominal surgery. Methods Eighty patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective retroperitoneal tumor resection, were divided into 2 groups (n=40 each) by a random number table method: stroke volume variation (SVV) 9%-14% group (L group, n=40) and SVV<9% group (H group, n=40). SVV 9%-14% and SVV<9% were used as the target and GDFT was performed though combing with cardiac index and mean arterial pressure.The concentrations of syndecan 1, hyaluronic acid, heparan sulfate, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in serum were determined at 5 min before skin incision (T0), 1 h after skin incision (T1), 4 h after skin incision (T2) and 24 and 72 h after operation (T3, 4). The intraoperative urine volume, blood loss, volume of liquid infused, volume of blood infused, amount of norepinephrine consumed, operation time, extubation time and length of postoperative hospital stay were recorded. Results Compared with the baseline value at T0, the concentrations of syndecan 1, hyaluronic acid, heparan sulfate, TNF-α and IL-6 in serum were significantly increased at T1-4 in H group, and the concentrations of syndecan 1, heparan sulfate, TNF-α and IL-6 in serum at T1-4 and concentrations of hyaluronic acid at T1-3 were significantly increased in L group (P<0.05). Compared with H group, the volume of liquid infused was significantly reduced, the amount of norepinephrine consumed was increased, the concentrations of syndecan 1, IL-6 and TNF-α in serum were decreased at T1-4, the concentrations of hyaluronic acid were decreased at T2, 3, and the concentrations of heparan sulfate were decreased at T1-3 in group L (P<0.05). Conclusion Compared with GDFT with the target of SVV<9%, GDFT with the target of SVV 9%-14% is more helpful in decreasing degradation of endothelial glycocalyx during the perioperative period and in reducing damage to endothelial barrier, and the mechanism may be related to inhibiting inflammatory responses of patients undergoing high-risk abdominal surgery. Key words: Fluid Therapy; Glycocalyx

Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study

PurposeTo explore effect of goal-directed fluid therapy (GDFT) on early cognitive function in elderly patients with spinal stenosis. Methods83 elderly patients with spinal stenosis were randomly classified into two groups: control group (n = 40) and GDFT group (n = 43). The Montreal Cognitive Assessment (MoCA) score, IL-6 and S100β levels, hemodynamic parameters, cerebral oxygen saturation (rSO2), arterial lactic acid values, output of surgery, operation time and cases of hypotension, intraoperative complications within 7 days were recorded for all patients. ResultsThe incidence of postoperative cognitive dysfunction (POCD) was about 21.67% in this study. The MoCA scores, inflammatory mediators, perfusion indexes (rSO2 and lactic acid)and intraoperative hemodynamics(HR, MAP, and CI)were not all the same at different time points (P < 0.05). The levels of inflammatory mediators (IL-6 and S100β) in GDFT group were lower than those in the control group (P < 0.05). Total intake, amount of lactated Ringer's solution and cases of hypotension in GDFT group were significantly lower than control group (P < 0.05), but amount of voluven was higher than control group(P < 0.05). Compared with control group, the incidence of postoperative delirium, nausea and vomiting, and hypotension in GDFT group was lower (P < 0.05). ConclusionsGDFT can maintain the stability of perioperative hemodynamics in the prone position of elderly patients with spinal stenosis, improve the balance between perfusion of tissue and organ and supply and demand of oxygen, reduce the inflammatory response, and reduce the incidence of early POCD in this type of surgery.

Clinical research of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer.

The aim of this study is to investigate the clinical effect of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer. Seventy-six elderly patients with radical resection of bladder cancer were selected from October 2012 to October 2014 and randomly divided into two groups, in which 38 patients received routine treatment as the control group and 38 patients received goal-directed fluid therapy based on routine treatment as the observation group. The treatment effect was compared between two groups. The cardiac index, stroke volume variability, mean arterial pressure, central venous pressure, central venous oxygen saturation, oxygen supply index, oxygen consumption index, and oxygen uptake rate in observation group were distinctly higher than those in control group at T1, T2, T3, and T4 while the artery serum lactate and S100-β were apparently lower than those in control group at T1, T2, T3, and T4. The urine volume and colloidal infusion were obviously elevated when compared with those in control group at T1, T2, T3, and T4 while the crystalloid infusion volume, total liquid infusion volume, hospitalization time, and expenses were significantly less than those in control group; further, similar tendency was also found regarding the complication incidences of nausea, vomiting, or hypotension in observation group. The postoperative flatus and postoperative food-taking times were visibly earlier than those in control group (both P < 0.05). The goal-directed fluid therapy is beneficial for stabilization of hemodynamic status and maintenance of oxygen balance of supply and demand, and it is worthy of clinical expansion for good microcirculation perfusion, reduction in therapeutic time and expenses of patients, and less complications and superior security.

Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program

The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge. The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P=0.034, P=0.0197, and P<0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P=0.0002). The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications. UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.

Effect of goal-directed fluid therapy on outcomes following abdominal surgery: a meta-analysis

Objective To systematically review the effect of goal-directed fluid therapy(GDFT)on outcomes following abdominal surgery. Methods Pubmed, Embase, CINAHAL, Scopus and Cochrane Library were searched from 1980 to May 2016 to identify randomized controlled trials involving the effect of GDFT on outcomes following abdominal surgery in adults(aged>18 yr). GDFT served as therapy group, and conventional fluid therapy served as control group.The major evaluation indexes included the postoperative mortality rate, incidence of postoperative complications and length of hospital stay.The secondary evaluation index was the recovery of postoperative gastrointestinal function.Meta-analysis was conducted using the RevMan 5.1 and Stata 12.0 softwares. Results Forty-five randomized controlled trials involving 6344 patients were included in our meta-analysis, and there were 3406 cases in therapy group and 2938 cases in control group.The results of meta-analysis showed that compared with control group, the number of patients who developed postoperative complications was significantly decreased, the length of hospital stay was shortened, and the time to first flatus and time to first liquid diet were shortened in therapy group(P 0.05). Conclusion GDFT can promote outcomes following abdominal surgery and exerts no effects on the survival rate in patients. Key words: Fluid therapy; Abdomen, surgery; Prognosis

Effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing surgery in prone position

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

Effect of goal-directed fluid therapy on postoperative cognitive function in patients undergoing intracranial tumor resection

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