Comparison of conventional fluid management with PVI-based goal-directed fluid management in elective colorectal surgery

Sevim Cesur, Tülay Çardaközü, Alparslan Kuş, Neşe Türkyılmaz, Ömer Yavuz, Sevim Cesur, Tülay Çardaközü, Alparslan Kuş, Neşe Türkyılmaz, Ömer Yavuz

Abstract

Intraoperative fluid management is quite important in terms of postoperative organ perfusion and complications. Different fluid management protocols are in use for this purpose. Our primary goal was to compare the effects of conventional fluid management (CFM) with the Pleth Variability Index (PVI) guided goal-directed fluid management (GDFM) protocols on the amount of crystalloids administered, blood lactate, and serum creatinine levels during the intraoperative period. The length of hospital stay was our secondary goal. Seventy ASA I-II elective colorectal surgery patients were randomly assigned to CFM or GDFM for fluid management. The hemodynamic data and the data obtained from ABG were recorded at the end of induction and during the follow-up period at 1 h intervals. In the preoperative period and at 24 h postoperatively, blood samples were taken for the measurement of hemoglobin, Na, K, Cl, serum creatinine, albumin and blood lactate. In the first 24 h after surgery, oliguria and the time of first bowel movement were recorded. Length of hospital stay was also recorded. Intraoperative crystalloid administration and urine output were statistically significantly higher in CFM group (p < 0.001, p: 0.018). The end-surgery fluid balance was significantly lower in Group GDFM. Preoperative and postoperative Na, K, Cl, serum albumin, serum creatinine, lactate and hemoglobin values were similar between the groups. The time to passage of stool was significantly short in Group-GDFM compared to Group-CFM (p = 0.016). The length of hospital stay was found to be similar in both group. PVI-guided GDFM might be an alternative to CFM in ASA I-II patients undergoing elective colorectal surgery. However, further studies need to be carried out to search the efficiency and safety of PVI.

Keywords: Colorectal surgery; Crystalloid fluid; Goal directed fluid management; Pleth variability index.

Conflict of interest statement

None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper. The authors declare that they have no conflict of interest to the publication of this article.

Figures

Fig. 1
Fig. 1
Study flow chart. CFM conventional fluid management, GDFM goal directed fluid management, PVI pleth variability index, MAP mean artery pressure, iv intravenous injection

References

    1. Doherty M, Buggy DJ. Intraoperative fluids: how much is too much? Br J Anaesth. 2012;109:69–79. doi: 10.1093/bja/aes171.
    1. Turkish Anaesthesiology and Reanimation Association (TARD). Perioperative goal directed treatment guideline, Turkey. 2014. .
    1. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literatüre review. Chest. 1999;115:1371–1377. doi: 10.1378/chest.115.5.1371.
    1. Holte K, Sharrock NE, Kehley H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002;89:622–632. doi: 10.1093/bja/aef220.
    1. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005;103:25–32. doi: 10.1097/00000542-200507000-00008.
    1. Patel S, Lutz JM, Panchagnula U, Bansal S. Anesthesia and perioperative management of colorectal surgical patients- specific issues (part 2) J Anaesthesiol Clin Pharmacol. 2012;28:304–313. doi: 10.4103/0970-9185.98321.
    1. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated mata-analysis and a plea for some common sense. Crit Care Med. 2013;41:1774–1781. doi: 10.1097/CCM.0b013e31828a25fd.
    1. Le Manach Y, Hofer CK, Lehot JJ, Vallet B, Goarin JP, Tavernier B, Cannesson M. Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period? Anesthesiology. 2012;117:1165–1174. doi: 10.1097/ALN.0b013e318275561d.
    1. McDermid RC, Raghunathan K, Romanovsky A, Shaw AD, Bagshaw SM. Controversies in fluid therapy: type, dose and toxicity. World J Crit Care Med. 2014;3:24–33. doi: 10.5492/wjccm.v3.i1.24.
    1. Della Rocca G, Vetrugno L, Tripi G, Deana C, Barbariol F, Livia Pompei L. Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach? BMC Anesthesiol. 2014;14:62–70. doi: 10.1186/1471-2253-14-62.
    1. Lambert KG, Wakim JH, Lambert NE. Preoperative fluid bolus and reduction of postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery. AANA J. 2009;77:110–114.
    1. Maharaj CH, Kallam SR, Malik A, Hassett P, Grady D, Laffey JG. Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesth Analg. 2005;100:675–682. doi: 10.1213/01.ANE.0000148684.64286.36.
    1. Bleier JIS, Aarons CB. Perioperative fluid restriction. Clin Colon Rectal Surg. 2013;26:197–202. doi: 10.1055/s-0033-1351139.
    1. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–648. doi: 10.1097/01.sla.0000094387.50865.23.
    1. Arkilic CF, Taguchi A, Sharma N, Ratnaraj J, Sessler DI, Read TE, Fleshman JW, Kurz A. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery. 2003;133:49–55. doi: 10.1067/msy.2003.80.
    1. Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P, Kehlet H. Liberal or restrictive fluid administration in fast-track colonic surgery:a randominized, double-blind study. Br J Anesth. 2007;99:500–508. doi: 10.1093/bja/aem211.
    1. Girish P, Joshi. Intraoperative fluid management. UpToDate. 2016. .
    1. Abraham-Nordling M, Hjern F, Pollack J, Prytz M, Borg T, Kressner U. Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg. 2012;99:186–191. doi: 10.1002/bjs.7702.
    1. Jacob M, Chappell D, Conzen P, Finsterer U, Rehm M. Blood volume is normal after preoperative overnight fasting. Acta Anaesthesiol Scand. 2008;52:522–529. doi: 10.1111/j.1399-6576.2008.01587.x.
    1. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–740. doi: 10.1097/ALN.0b013e3181863117.
    1. Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol. 2006;20:265–283. doi: 10.1016/j.bpa.2005.10.007.
    1. Lassen K. Intravenous fluid therapy. Br J Surg. 2009;96:123–124. doi: 10.1002/bjs.6466.
    1. Lobo DN. Fluid overload and surgical outcome: another piece in the jigsaw. Ann Surg. 2009;249:186–188. doi: 10.1097/SLA.0b013e318197bdfc.
    1. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2009;103:637–646. doi: 10.1093/bja/aep279.
    1. Phan TD, Ismail H, Heriot AG, Ho KM. Improving perioperative outcomes: fluid optimization with the esophageal Doppler monitor, a metaanalysis and review. J Am Coll Surg. 2008;207:935–941. doi: 10.1016/j.jamcollsurg.2008.08.007.
    1. Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012;114:640–651. doi: 10.1213/ANE.0b013e318240d6eb.
    1. Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, Hinds C, Rowan K. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311:2181–2190. doi: 10.1001/jama.2014.5305.
    1. Forget P, Lois F, Kock M. Goal directed fluid management based on the pulse oximeter derived pleth variability index reduces lactate and improves fluid management. Anesth Analg. 2010;111:910–914.
    1. Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3:12–20. doi: 10.1186/2110-5820-3-12.
    1. Schmid S, Kapfer B, Heim M, Bogdanski R, Anetsberger A, Blobner M, Jungwirth B. Algorithm guided goal-directed haemodynamic therapy does not improve renal function after major abdominal surgery compared to good standard clinical care—a prospective randomised trial. Crit Care. 2016;20:50–61. doi: 10.1186/s13054-016-1237-1.
    1. Iregui MG, Prentice D, Sherman G, Schallom L, Sona C, Kollef MH. Physician’sestimates of cardiac index and intravascular volume based on clinical assessment versus transesophageal Doppler measurements obtained by critical care nurses. Am J Crit Care. 2003;12:336–342.
    1. Magder S, Georgiadis G, Cheong T. Respiratory variations in right atrial pressure predict the response to fluid challenge. Crit Care. 1992;7:76–85. doi: 10.1016/0883-9441(92)90032-3.
    1. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172–178. doi: 10.1378/chest.07-2331.
    1. Magder S, Bafaqeeh F. The clinical role of central venous pressure measurements. Intensive Care Med. 2007;22:44–51. doi: 10.1177/0885066606295303.
    1. Thiele RH, Bartels K, Gan TJ. Inter-device differences in monitoring for goal-directed fluid therapy. Can J Anaesth. 2015;62:169–181. doi: 10.1007/s12630-014-0265-z.
    1. Magder S. Fluid status and fluid responsiveness. Curr Opin Crit Care. 2010;16:289–296. doi: 10.1097/MCC.0b013e32833b6bab.
    1. Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting. Anesth Analg. 2009;108:887–897. doi: 10.1213/ane.0b013e31818ffd99.
    1. Desebbe O, Cannesson M. Using ventilation-induced plethysmographic variations to optimize patient fluid status. Curr Opin Anaesthesiol. 2008;21:772–778. doi: 10.1097/ACO.0b013e32831504ca.
    1. Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care. 2011;17:290–295. doi: 10.1097/MCC.0b013e32834699cd.
    1. Ansari BM, Zochios V, Falter F, Klein AA. Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review. Anaesthesia. 2016;71:94–105. doi: 10.1111/anae.13246.
    1. Brandstrup B, Svendsen PE, Rasmussen M, Belhage B, Rodt S, Hansen B, Møller DR, Lundbech LB, Andersen N, Berg V, Thomassen N, Andersen ST, Simonsen L. Which goal for fluid therapy during colorectal surgery is followed by the best outcome:near-maximal stoke volume or zero fluid balance? Br J Anaesth. 2012;109:191–199. doi: 10.1093/bja/aes163.
    1. Yu Y, Dong J, Xu Z, Shen H, Zheng J. Pleth variability index-directed fluid management in abdominal surgery under combined general and epidural anesthesia. J Clin Monit Comput. 2015;29:47–52. doi: 10.1007/s10877-014-9567-5.
    1. Hood JA, Wilson RJT. Pleth variability index to predict fluid responsiveness in colorectal surgery. Anesth Analg. 2011;113:1058–1063. doi: 10.1213/ANE.0b013e31822c10cd.
    1. Monnet X, Guerin L, Jozwiak M, Bataille A, Julien F, Richard C, Teboul JL, Monnet X, Guerin L, Jozwiak M. Pleth variability index is a weak predictor of fluid responsiveness in patients receiving norepinephrine. Br J Anaesth. 2013;110:207–213. doi: 10.1093/bja/aes373.

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