Department of Anesthesiology, CHU Brugmann, 4, Place Van Gehuchten, 1020, Bruxelles, Belgium.
Université Libre de Bruxelles, Brussels, Belgium.
BMC Anesthesiol. 2019 Mar 9;19(1):34. doi: 10.1186/s12871-019-0707-9.
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.
Patients were randomized into either PVI or PPV guided GDFT groups. Both received a baseline 2 ml kg h 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.
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.
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.
ClinicalTrials.gov Identifier: NCT02908256 , September 2016, retrospectively registered.
基于血流动力学反应的目标导向液体治疗（GDFT）已被证明可降低接受大腹部手术的患者的术后并发症和住院时间（LOS）。这种方法在低风险至中度风险的腹部手术中仍需要进一步明确。脉压变异（PPV）和容积描记变异指数（PVI）都可用于指导 GDFT 策略。本前瞻性随机对照试验的目的是确定与 PPV 指导的 GDFT 相比，使用 PVI 指导的 GDFT 是否会导致接受低风险至中度风险手术的患者的 LOS 相似。次要结局包括给予的液体量和术后并发症的发生率。
患者随机分为 PVI 或 PPV 指导的 GDFT 组。两组均接受基础 2ml/kg/h 乳酸林格氏液输注。如果 PVI > 15%或 PPV > 13%持续至少 5 分钟，则在 10 分钟内输注 250ml 胶体作为额外的液体冲击量。主要结局是确定手术日至外科医生批准出院日的 LOS 是否等效于两组之间的 LOS。
共有 76 名患者入组，随机分为两组，每组 38 名患者。两组的基线特征相似。PVI 和 PPV 指导的 GDFT 策略在 LOS 的主要结局（中位数[四分位间距]）（天）2.5 [2.0-3.3]与 3.0 [2.0-5.0]方面等效，p=0.230。两组之间输注的液体量、术后并发症和所有其他结局均无差异。
在接受低风险至中度风险腹部手术的患者中，PVI 似乎在 LOS、液体量和术后并发症发生率方面与 PPV 一样能指导 GDFT。然而，在接受这些手术程序的低风险患者中，优化每搏量可能对结局的影响有限。
ClinicalTrials.gov 标识符：NCT02908256，2016 年 9 月，回顾性注册。
