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Randomized Controlled Trial
. 2019 Mar 9;19(1):34.
doi: 10.1186/s12871-019-0707-9.

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

Sean Coeckelenbergh  1   2 , Amélie Delaporte  3   4 , Djamal Ghoundiwal  3   4 , Javad Bidgoli  3   4 , Jean-François Fils  3   5 , Denis Schmartz  3   4 , Philippe Van der Linden  3   4
Affiliations
Randomized Controlled Trial

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

Sean Coeckelenbergh et al. BMC Anesthesiol. .

Abstract

Background: Goal-directed fluid therapy (GDFT) based on dynamic indicators of fluid responsiveness has been shown to decrease postoperative complications and hospital length of stay (LOS) in patients undergoing major abdominal surgery. The usefulness of this approach still needs to be clarified in low-to-moderate risk abdominal surgery. Both pulse-pressure variation (PPV) and pleth variability index (PVI) can be used to guide GDFT strategies. The objective of this prospective randomized controlled trial was to determine if the use of PVI guided GDFT, when compared to PPV guided GDFT, would lead to similar hospital LOS in patients undergoing low-to-moderate risk surgery. Secondary outcomes included amount of fluid administered and incidence of postoperative complications.

Methods: Patients were randomized into either PVI or PPV guided GDFT groups. Both received a baseline 2 ml kg- 1 h- 1 Lactated Ringer infusion. Additional fluid boluses consisted of 250 mL of colloid that was infused over a 10 min period if PVI was > 15% or PPV was > 13% for at least five minutes. The primary outcome was to determine if hospital LOS, which was defined as the number of days from surgery up to the day the surgeon authorized hospital discharge, was equivalent between the two groups.

Results: A total of 76 patients were included and they were randomized into two groups of 38 patients. Baseline characteristics were similar in both groups. Both PVI and PPV guided GDFT strategies were equivalent for the primary outcome of LOS (median [interquartile range]) (days) 2.5 [2.0-3.3] vs. 3.0 [2.0-5.0], p = 0.230, respectively. Fluids infused, postoperative complications, and all other outcomes were not different between groups.

Conclusion: In patients undergoing low-to-moderate risk abdominal surgery, PVI seems to guide GDFT similarly to PPV in regards to hospital LOS, amount of fluid, and incidence of postoperative complications. However, in low-risk patients undergoing these surgical procedures optimizing stroke volume may have limited impact on outcome.

Trial registration: ClinicalTrials.gov Identifier: NCT02908256 , September 2016, retrospectively registered.

Keywords: Anesthesia; Anesthesiology; Colloids; Crystalloids; Fluid responsiveness; Goal-directed therapy; Hemodynamics.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the CHU Brugmann ethical committee and patients gave written informed consent.

Consent for publication

not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Goal-directed fluid therapy protocols. Patients were randomized into either PVI or PPV guided groups. PPV pulse pressure variation, PVI Pleth variability index
Fig. 2
Fig. 2
Flow chart of enrolment, allocation, and analysis
Fig. 3
Fig. 3
Box-plot comparison of the primary outcome, length of stay (LOS). (*) In order to improve readability, one outlier (LOS = 35 days) is not represented in this figure
See this image and copyright information in PMC

References

    1. Salzwedel C, Puig J, Carstens A, Bein B, Molnar Z, Kiss K, Hussain A, Belda J, Kirov MY, Sakka SG, Reuter DA. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care. 2013;17(5):R191. doi: 10.1186/cc12885. - DOI - PMC - PubMed
    1. Joosten A, Coeckelenbergh S, Delaporte A, Ickx B, Closset J, Roumeguere T, Barvais L, Van Obbergh L, Cannesson M, Rinehart J, Van der Linden P. Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery: a case-control study with propensity matching. Eur J Anaesthesiol. 2018;35(9):650–658. - PubMed
    1. Pearse RM, Harrison DA, MacDonald N, Gillies MA, et al. 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(21):2181–2190. doi: 10.1001/jama.2014.5305. - DOI - PubMed
    1. Lee S, Chun Y, Oh Y, Shin S, Park S, Kim S, Choi Y. Prediction of fluid responsiveness in the beach chair position using dynamic preload indices. J Clin Monit Comput. 2016;30(6):995–1002. doi: 10.1007/s10877-015-9821-5. - DOI - PubMed
    1. Wu C, Cheng Y, Liu Y, Wu T, Chien C, Chan K. Predicting stroke volume and arterial pressure fluid responsiveness in liver cirrhosis patients using dynamic preload variables: a prospective study of diagnostic accuracy. Eur J Anaesthesiol. 2016;33(9):645–652. doi: 10.1097/EJA.0000000000000479. - DOI - PubMed

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