Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt.
Department of Anaesthesiology, Armed Forces College of Medicine, Egypt.
Anaesthesiol Intensive Ther. 2023;55(3):186-195. doi: 10.5114/ait.2023.130792.
The plethysmographic variability index (PVI) is a dynamic approach for assessing volume status. This study aims to compare conventional fluid management and PVI based goal-directed fluid management (GDFM) during elective spine surgery in the prone position.
Sixty-six adult patients, ASA I-II, scheduled for elective lumbar spine procedures under general anaesthesia in the prone position were included. Patients were randomly divided into either the Conventional Group with the conventional fluid management protocol or the PVI Group with the PVI-based GDFM protocol. The total amount of intraoperative crystalloid administered was set as a primary outcome. Intraoperative PVI and perfusion index (PI), mean arterial pressure (MAP), heart rate (HR), the incidence of hypotension after prone positioning in both groups and data from arterial blood gas samples (immediately after induction of anaesthesia [T1] and immediately postoperatively [T2]) were set as secondary outcomes.
The total amount of intraoperative crystalloids, blood transfusion, urine output, and fluid balance were similar in the two groups ( P -values 0.443, 0.317 and 0.273, respectively). The perioperative MAP and HR values showed no significant differences between the two groups at all time points of measurements. The values of pH, PaO 2 , PaCO 2 , HCO 3 , lactate and haemoglobin showed no statistically significant difference between the two groups. The blood lactate value at T2 was significantly increased when compared to T1 values in the two groups.
PVI dependent goal-directed fluid management (GDFM) therapy did not reduce the intraoperative total crystalloid administration or requirements for blood transfusion when compared to conventional fluid management using a fixed fluid rate in patients undergoing spine surgery in a prone position. Clinical trial registration: The study was registered at clinicaltrials.gov (NCT05239286).
容积描记变异指数（PVI）是一种评估容量状态的动态方法。本研究旨在比较在全身麻醉下俯卧位行择期脊柱手术时常规液体管理与基于 PVI 的目标导向液体管理（GDFM）。
纳入 66 例 ASA I-II 级择期行全身麻醉下俯卧位腰椎手术的成年患者。患者随机分为常规组（采用常规液体管理方案）和 PVI 组（采用基于 PVI 的 GDFM 方案）。术中晶体液的总用量为主要观察指标。术中 PVI 和灌注指数（PI）、平均动脉压（MAP）、心率（HR）、两组患者俯卧位后低血压的发生率以及动脉血气样本（麻醉诱导即刻[T1]和术后即刻[T2]）的数据为次要观察指标。
两组患者术中晶体液用量、输血、尿量和液体平衡无显著差异（P 值分别为 0.443、0.317 和 0.273）。两组患者在各测量时间点的围术期 MAP 和 HR 值均无显著差异。两组患者的 pH、PaO2、PaCO2、HCO3-、乳酸和血红蛋白值无统计学差异。与 T1 值相比，两组患者 T2 时的血乳酸值显著升高。
与采用固定输液速度的常规液体管理相比，在俯卧位行脊柱手术的患者中，基于 PVI 的目标导向液体管理（GDFM）治疗并未减少术中总晶体液用量或输血需求。临床试验注册：本研究在 clinicaltrials.gov 注册（NCT05239286）。
