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Randomized Controlled Trial
. 2019 Apr;33(2):249-257.
doi: 10.1007/s10877-018-0163-y. Epub 2018 Jun 14.

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

Sevim Cesur  1 , Tülay Çardaközü  2 , Alparslan Kuş  2 , Neşe Türkyılmaz  2 , Ömer Yavuz  3
Affiliations
Randomized Controlled Trial

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

Sevim Cesur et al. J Clin Monit Comput. 2019 Apr.

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.

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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
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