Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Paediatr Anaesth. 2024 Jun;34(6):559-567. doi: 10.1111/pan.14856. Epub 2024 Feb 13.
Intraoperative fluid therapy maintains normovolemia, normal tissue perfusion, normal metabolic function, normal electrolytes, and acid-base status. Plethysmographic variability index has been shown to predict fluid responsiveness but its role in guiding intraoperative fluid therapy is still elusive.
The aim of the present study was to compare intraoperative goal-directed fluid therapy based on plethysmographic variability index with liberal fluid therapy in term neonates undergoing abdominal surgeries.
A prospective randomized controlled study was conducted in a tertiary care centre, over a period of 18 months. A total of 30 neonates completed the study out of 132 neonates screened. Neonates with tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease, respiratory disorders, creatinine clearance <90 mL/min and who were hemodynamically unstable were excluded. Neonates were randomized to goal-directed fluid therapy group where the plethysmographic variability index was targeted at <18 or liberal fluid therapy group. Primary outcome was comparison of total amount of fluid infused intraoperatively in both the groups. Secondary outcomes included intraoperative and postoperative arterial blood gas parameters, biochemical parameters, use of vasopressors, number of fluid boluses, complications and duration of hospital stay.
There was no significant difference in total intraoperative fluid infused [90 (84-117.5 mL) in goal-directed fluid therapy and 105 (85.5-144.5 mL) in liberal fluid therapy group (p = .406)], median difference (95% CI) -15 (-49.1 to 19.1). There was a decrease in serum lactate levels in both groups from preoperative to postoperative 24 h. The amount of fluid infused before dopamine administration was significantly higher in liberal fluid therapy group (58 [50.25-65 mL]) compared to goal-directed fluid therapy group (36 [22-44 mL], p = .008), median difference (95% CI) -22 (-46 to 2). In postoperative period, the total amount of fluid intake over 24 h was comparable in two groups (222 [204-253 mL] in goal-directed fluid therapy group and 224 [179.5-289.5 mL] in liberal fluid therapy group, p = .917) median difference (95% CI) cutoff -2 (-65.3 to 61.2).
Intraoperative plethysmographic variability index-guided goal-directed fluid therapy was comparable to liberal fluid therapy in terms of total volume of fluid infused in neonates during perioperative period. More randomized controlled trials with higher sample size are required.
Central Trial Registry of India (CTRI/2020/02/023561).
术中液体治疗维持正常血容量、正常组织灌注、正常代谢功能、正常电解质和酸碱平衡状态。容积描记变异指数已被证明可预测液体反应性，但指导术中液体治疗的作用仍不清楚。
本研究旨在比较基于容积描记变异指数的术中目标导向液体治疗与开放性液体治疗在接受腹部手术的足月新生儿中的应用。
这是一项在三级保健中心进行的前瞻性随机对照研究，持续了 18 个月。在筛查的 132 名新生儿中，共有 30 名新生儿完成了研究。排除患有气管食管瘘、先天性膈疝、先天性心脏病、呼吸障碍、肌酐清除率<90 mL/min 和血流动力学不稳定的新生儿。将新生儿随机分为目标导向液体治疗组，将容积描记变异指数目标设定为<18 或开放性液体治疗组。主要结局是比较两组术中输注的总液体量。次要结局包括术中及术后动脉血气参数、生化参数、血管加压药使用、液体冲击量、并发症和住院时间。
两组术中输注的总液体量无显著差异[目标导向液体治疗组 90（84-117.5ml）和开放性液体治疗组 105（85.5-144.5ml）（p=0.406）]，中位数差异（95%CI）-15（-49.1 至 19.1）。两组的血清乳酸水平均从术前降至术后 24 小时。开放性液体治疗组在给予多巴胺前输注的液体量明显高于目标导向液体治疗组（58[50.25-65ml]），差异有统计学意义（p=0.008），中位数差异（95%CI）-22（-46 至 2）。在术后期间，两组 24 小时总液体摄入量相似[目标导向液体治疗组 222（204-253ml）和开放性液体治疗组 224（179.5-289.5ml），差异无统计学意义（p=0.917），中位数差异（95%CI）-2（-65.3 至 61.2）。
在围手术期，新生儿术中容积描记变异指数指导的目标导向液体治疗与开放性液体治疗在输注的总液体量方面相似。需要更多具有更大样本量的随机对照试验。
印度中央临床试验注册中心（CTRI/2020/02/023561）。
