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Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study.
Crit Care. 2010; 14(3):R118.CC

Abstract

INTRODUCTION

Stroke volume variation (SVV) is a good and easily obtainable predictor of fluid responsiveness, which can be used to guide fluid therapy in mechanically ventilated patients. During major abdominal surgery, inappropriate fluid management may result in occult organ hypoperfusion or fluid overload in patients with compromised cardiovascular reserves and thus increase postoperative morbidity. The aim of our study was to evaluate the influence of SVV guided fluid optimization on organ functions and postoperative morbidity in high risk patients undergoing major abdominal surgery.

METHODS

Patients undergoing elective intraabdominal surgery were randomly assigned to a Control group (n = 60) with routine intraoperative care and a Vigileo group (n = 60), where fluid management was guided by SVV (Vigileo/FloTrac system). The aim was to maintain the SVV below 10% using colloid boluses of 3 ml/kg. The laboratory parameters of organ hypoperfusion in perioperative period, the number of infectious and organ complications on day 30 after the operation, and the hospital and ICU length of stay and mortality were evaluated. The local ethics committee approved the study.

RESULTS

The patients in the Vigileo group received more colloid (1425 ml [1000-1500] vs. 1000 ml [540-1250]; P = 0.0028) intraoperatively and a lower number of hypotensive events were observed (2[1-2] Vigileo vs. 3.5[2-6] in Control; P = 0.0001). Lactate levels at the end of surgery were lower in Vigileo (1.78 +/- 0.83 mmol/l vs. 2.25 +/- 1.12 mmol/l; P = 0.0252). Fewer Vigileo patients developed complications (18 (30%) vs. 35 (58.3%) patients; P = 0.0033) and the overall number of complications was also reduced (34 vs. 77 complications in Vigileo and Control respectively; P = 0.0066). A difference in hospital length of stay was found only in per protocol analysis of patients receiving optimization (9 [8-12] vs. 10 [8-19] days; P = 0.0421). No difference in mortality (1 (1.7%) vs. 2 (3.3%); P = 1.0) and ICU length of stay (3 [2-5] vs. 3 [0.5-5]; P = 0.789) was found.

CONCLUSIONS

In this study, fluid optimization guided by SVV during major abdominal surgery is associated with better intraoperative hemodynamic stability, decrease in serum lactate at the end of surgery and lower incidence of postoperative organ complications.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN95085011.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care, Charles University teaching hospital, alej Svobody 80, Plzen 304 60, Czech Republic. benesj@fnplzen.czNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20553586

Citation

Benes, Jan, et al. "Intraoperative Fluid Optimization Using Stroke Volume Variation in High Risk Surgical Patients: Results of Prospective Randomized Study." Critical Care (London, England), vol. 14, no. 3, 2010, pp. R118.
Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care. 2010;14(3):R118.
Benes, J., Chytra, I., Altmann, P., Hluchy, M., Kasal, E., Svitak, R., Pradl, R., & Stepan, M. (2010). Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Critical Care (London, England), 14(3), R118. https://doi.org/10.1186/cc9070
Benes J, et al. Intraoperative Fluid Optimization Using Stroke Volume Variation in High Risk Surgical Patients: Results of Prospective Randomized Study. Crit Care. 2010;14(3):R118. PubMed PMID: 20553586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. AU - Benes,Jan, AU - Chytra,Ivan, AU - Altmann,Pavel, AU - Hluchy,Marek, AU - Kasal,Eduard, AU - Svitak,Roman, AU - Pradl,Richard, AU - Stepan,Martin, Y1 - 2010/06/16/ PY - 2010/01/12/received PY - 2010/05/04/revised PY - 2010/06/16/accepted PY - 2010/6/18/entrez PY - 2010/6/18/pubmed PY - 2011/1/7/medline SP - R118 EP - R118 JF - Critical care (London, England) JO - Crit Care VL - 14 IS - 3 N2 - INTRODUCTION: Stroke volume variation (SVV) is a good and easily obtainable predictor of fluid responsiveness, which can be used to guide fluid therapy in mechanically ventilated patients. During major abdominal surgery, inappropriate fluid management may result in occult organ hypoperfusion or fluid overload in patients with compromised cardiovascular reserves and thus increase postoperative morbidity. The aim of our study was to evaluate the influence of SVV guided fluid optimization on organ functions and postoperative morbidity in high risk patients undergoing major abdominal surgery. METHODS: Patients undergoing elective intraabdominal surgery were randomly assigned to a Control group (n = 60) with routine intraoperative care and a Vigileo group (n = 60), where fluid management was guided by SVV (Vigileo/FloTrac system). The aim was to maintain the SVV below 10% using colloid boluses of 3 ml/kg. The laboratory parameters of organ hypoperfusion in perioperative period, the number of infectious and organ complications on day 30 after the operation, and the hospital and ICU length of stay and mortality were evaluated. The local ethics committee approved the study. RESULTS: The patients in the Vigileo group received more colloid (1425 ml [1000-1500] vs. 1000 ml [540-1250]; P = 0.0028) intraoperatively and a lower number of hypotensive events were observed (2[1-2] Vigileo vs. 3.5[2-6] in Control; P = 0.0001). Lactate levels at the end of surgery were lower in Vigileo (1.78 +/- 0.83 mmol/l vs. 2.25 +/- 1.12 mmol/l; P = 0.0252). Fewer Vigileo patients developed complications (18 (30%) vs. 35 (58.3%) patients; P = 0.0033) and the overall number of complications was also reduced (34 vs. 77 complications in Vigileo and Control respectively; P = 0.0066). A difference in hospital length of stay was found only in per protocol analysis of patients receiving optimization (9 [8-12] vs. 10 [8-19] days; P = 0.0421). No difference in mortality (1 (1.7%) vs. 2 (3.3%); P = 1.0) and ICU length of stay (3 [2-5] vs. 3 [0.5-5]; P = 0.789) was found. CONCLUSIONS: In this study, fluid optimization guided by SVV during major abdominal surgery is associated with better intraoperative hemodynamic stability, decrease in serum lactate at the end of surgery and lower incidence of postoperative organ complications. TRIAL REGISTRATION: Current Controlled Trials ISRCTN95085011. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/20553586/Intraoperative_fluid_optimization_using_stroke_volume_variation_in_high_risk_surgical_patients:_results_of_prospective_randomized_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc9070 DB - PRIME DP - Unbound Medicine ER -