Bahlmann Hans, Hahn Robert G, Nilsson Lena
Department of Medical and Health Sciences, Linköping University, University Hospital, 58185, Linköping, Sweden.
Department of Anesthesiology and Intensive Care, Linköping University, University Hospital, 58185, Linköping, Sweden.
BMC Anesthesiol. 2018 Aug 18;18(1):115. doi: 10.1186/s12871-018-0579-4.
The impact of Goal Directed Fluid Therapy (GDFT) based on the non-invasive Pleth Variability Index (PVI) on clinical outcome after abdominal surgery has only sparingly been explored. The purpose of this study was to compare the effect of intraoperative GDFT guided by PVI to a control group using esophageal Doppler on the incidence of complications and length of hospital stay after major abdominal surgery. We hypothesized that there would be no difference between the groups.
This was a randomized controlled trial in a Swedish university hospital between November 2011 and January 2015; 150 patients scheduled for open abdominal surgery lasting 2 h or more were included. Exclusion criteria included hepatic resection or severe cardiac arrhythmia. The patients were randomized 1:1 to either the intervention group or the control group. The intervention group received intraoperative GDFT by administering fluid boluses of 3 ml/kg tetrastarch aiming at a PVI value below 10%, while GDFT in the control group aimed for optimization of stroke volume as assessed with esophageal Doppler. Blinded observers assessed complications until postoperative day 30 using pre-defined definitions, as well as length of hospital stay.
One hundred and-fifty patients were randomized and 146 patients were available for the final data analysis. Median duration of surgery was 3 h. A total of 64 complications occurred in the PVI group (N = 74) and 70 in the Doppler group (N = 72) (p = 0.93). Median (IQR) length of stay was 8.0 (8.0) days in the PVI group and 8.0 (9.5) in the Doppler group (P = 0.57).
No difference in clinical outcome, as defined by number of postoperative complications, and length of hospital stay, was found when goal directed fluid therapy was applied using PVI as an alternative to esophageal Doppler. PVI appears to be an acceptable alternative to esophageal Doppler for goal directed fluid therapy during major open abdominal surgery.
Clinicaltrials.gov NCT01458678 . Date of first registration October 20, 2011.
基于无创脉搏波变异指数（PVI）的目标导向液体治疗（GDFT）对腹部手术后临床结局的影响鲜有研究。本研究旨在比较术中以PVI为导向的GDFT与使用食管多普勒的对照组在腹部大手术后并发症发生率和住院时间方面的效果。我们假设两组之间无差异。
这是一项于2011年11月至2015年1月在瑞典一家大学医院进行的随机对照试验；纳入150例计划进行持续2小时或更长时间的开腹手术的患者。排除标准包括肝切除术或严重心律失常。患者按1:1随机分为干预组或对照组。干预组通过给予3ml/kg的羟乙基淀粉液体冲击量进行术中GDFT，目标是使PVI值低于10%，而对照组的GDFT旨在通过食管多普勒评估优化每搏输出量。 blinded观察者使用预定义的定义评估术后30天内的并发症以及住院时间。
150例患者被随机分组，146例患者可用于最终数据分析。手术中位持续时间为3小时。PVI组（N = 74）共发生64例并发症，多普勒组（N = 72）共发生70例并发症（p = 0.93）。PVI组的中位（IQR）住院时间为8.0（8.0）天，多普勒组为8.0（9.5）天（P = 0.57）。
当使用PVI替代食管多普勒进行目标导向液体治疗时，在术后并发症数量和住院时间所定义的临床结局方面未发现差异。在腹部大手术的目标导向液体治疗中，PVI似乎是食管多普勒的可接受替代方法。
Clinicaltrials.gov NCT01458678。首次注册日期为2011年10月20日。
