Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

Jian Zhang, Chao Qin Chen, Xiu Zhen Lei, Zhi Ying Feng, Sheng Mei Zhu, Jian Zhang, Chao Qin Chen, Xiu Zhen Lei, Zhi Ying Feng, Sheng Mei Zhu

Abstract

Objectives: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies.

Methods: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded.

Results: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group.

Conclusion: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting) in thoracic surgery patients requiring one-lung ventilation.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Fluid management protocol based on SVV and CI (CI, cardiac index; SVV, stroke volume variation; PEEP, positive end-expiratory pressure; VT, tidal volume; FiO2, fraction of inspired oxygen).
Figure 2
Figure 2
SVV and Frank-Starling curve. The relationship between preload and SV in different left ventricular functions. Individual cardiac function could cause different cardiac reactions to a fluid bolus.

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Source: PubMed

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