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Randomized Controlled Trial
. 2012 Oct;67(10):1149-55.
doi: 10.6061/clinics/2012(10)06.

Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive

Jun Zhang  1 , Hui Qiao, Zhiyong He, Yun Wang, Xuehua Che, Weimin Liang
Affiliations
Randomized Controlled Trial

Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive

Jun Zhang et al. Clinics (Sao Paulo). 2012 Oct.

Abstract

Objective: The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution.

Method: A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints.

Results: The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups.

Conclusion: Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Intraoperative fluid infusion volume.
Figure 2
Figure 2
Time to first passage of flatus.
Figure 3
Figure 3
Postoperative days of hospital stay.
See this image and copyright information in PMC

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