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. 2023 Jul 10;12(1):33.
doi: 10.1186/s13741-023-00327-x.

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

Hongmei Ma  1   2 , Xin Li  1 , Zhe Wang  3 , Qiao Qiao  1 , Yanfeng Gao  1 , Hui Yuan  1 , Bin Guan  1 , Zheng Guan  4
Affiliations

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

Hongmei Ma et al. Perioper Med (Lond). .

Abstract

Background: To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection.

Methods: Patients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared.

Results: Two-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048).

Conclusions: Under ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group.

Trial registration: Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.

Keywords: Acute kidney injury; Enhanced recovery after surgery; Goal-directed fluid therapy; Pulmonary resection.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram. GDFT goal-directed fluid therapy, RFT restrictive fluid therapy
Fig. 2
Fig. 2
The GDFT protocol. SVV stroke volume variation, MAP mean arterial pressure, CI cardiac index
Fig. 3
Fig. 3
The ERAS program implementation rate. TIVA total intravenous anesthesia, OLV one-lung ventilation
Fig. 4
Fig. 4
The preoperative and postoperative biochemical parameters. *Compared between groups, P = 0.048
Fig. 5
Fig. 5
The intraoperative hemodynamic parameters. MAP mean arterial pressure, SVV stroke volume variation, CI cardiac index. *Compared to T1 within groups, P < 0.05
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