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Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial.
J Am Coll Surg. 2015 Aug; 221(2):591-601.JA

Abstract

BACKGROUND

The optimal perioperative fluid resuscitation strategy for liver resections remains undefined. Goal-directed therapy (GDT) embodies a number of physiologic strategies to achieve an ideal fluid balance and avoid the consequences of over- or under-resuscitation.

STUDY DESIGN

In a prospective randomized trial, patients undergoing liver resection were randomized to GDT using stroke volume variation as an end point or to standard perioperative resuscitation. Primary outcomes measure was 30-day morbidity.

RESULTS

Between 2012 and 2014, one hundred and thirty-five patients were randomized (GDT: n = 69; standard perioperative resuscitation: n = 66). Median age was 57 years and 56% were male. Metastatic disease comprised 81% of patients. Overall (35% GDT vs 36% standard perioperative resuscitation; p = 0.86) and grade 3 morbidity (28% GDT vs 18% standard perioperative resuscitation; p = 0.22) were equivalent. Patients in the GDT arm received less intraoperative fluid (mean 2.0 L GDT vs 2.9 L standard perioperative resuscitation; p < 0.001). Perioperative transfusions were required in 4% (6% GDT vs 2% standard perioperative resuscitation; p = 0.37) and boluses in the postanesthesia care unit were administered to 24% (29% GDT vs 20% standard perioperative resuscitation; p = 0.23). Mortality rate was 1% (2 of 135 patients; both in GDT). On multivariable analysis, male sex, age, combined procedures, higher intraoperative fluid volume, and fluid boluses in the postanesthesia care unit were associated with higher 30-day morbidity.

CONCLUSIONS

Stroke volume variation-guided GDT is safe in patients undergoing liver resection and led to less intraoperative fluid. Although the incidence of postoperative complications was similar in both arms, lower intraoperative resuscitation volume was independently associated with decreased postoperative morbidity in the entire cohort. Future studies should target extensive resections and identify patients receiving large resuscitation volumes, as this population is more likely to benefit from this technique.

Authors+Show Affiliations

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: fischerm@mskcc.org.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26206652

Citation

Correa-Gallego, Camilo, et al. "Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation After Low Central Venous Pressure-Assisted Liver Resection: a Randomized Clinical Trial." Journal of the American College of Surgeons, vol. 221, no. 2, 2015, pp. 591-601.
Correa-Gallego C, Tan KS, Arslan-Carlon V, et al. Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. J Am Coll Surg. 2015;221(2):591-601.
Correa-Gallego, C., Tan, K. S., Arslan-Carlon, V., Gonen, M., Denis, S. C., Langdon-Embry, L., Grant, F., Kingham, T. P., DeMatteo, R. P., Allen, P. J., D'Angelica, M. I., Jarnagin, W. R., & Fischer, M. (2015). Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. Journal of the American College of Surgeons, 221(2), 591-601. https://doi.org/10.1016/j.jamcollsurg.2015.03.050
Correa-Gallego C, et al. Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation After Low Central Venous Pressure-Assisted Liver Resection: a Randomized Clinical Trial. J Am Coll Surg. 2015;221(2):591-601. PubMed PMID: 26206652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. AU - Correa-Gallego,Camilo, AU - Tan,Kay See, AU - Arslan-Carlon,Vittoria, AU - Gonen,Mithat, AU - Denis,Stephanie C, AU - Langdon-Embry,Liana, AU - Grant,Florence, AU - Kingham,T Peter, AU - DeMatteo,Ronald P, AU - Allen,Peter J, AU - D'Angelica,Michael I, AU - Jarnagin,William R, AU - Fischer,Mary, Y1 - 2015/04/07/ PY - 2015/02/15/received PY - 2015/03/18/revised PY - 2015/03/27/accepted PY - 2015/7/25/entrez PY - 2015/7/25/pubmed PY - 2015/10/6/medline SP - 591 EP - 601 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 221 IS - 2 N2 - BACKGROUND: The optimal perioperative fluid resuscitation strategy for liver resections remains undefined. Goal-directed therapy (GDT) embodies a number of physiologic strategies to achieve an ideal fluid balance and avoid the consequences of over- or under-resuscitation. STUDY DESIGN: In a prospective randomized trial, patients undergoing liver resection were randomized to GDT using stroke volume variation as an end point or to standard perioperative resuscitation. Primary outcomes measure was 30-day morbidity. RESULTS: Between 2012 and 2014, one hundred and thirty-five patients were randomized (GDT: n = 69; standard perioperative resuscitation: n = 66). Median age was 57 years and 56% were male. Metastatic disease comprised 81% of patients. Overall (35% GDT vs 36% standard perioperative resuscitation; p = 0.86) and grade 3 morbidity (28% GDT vs 18% standard perioperative resuscitation; p = 0.22) were equivalent. Patients in the GDT arm received less intraoperative fluid (mean 2.0 L GDT vs 2.9 L standard perioperative resuscitation; p < 0.001). Perioperative transfusions were required in 4% (6% GDT vs 2% standard perioperative resuscitation; p = 0.37) and boluses in the postanesthesia care unit were administered to 24% (29% GDT vs 20% standard perioperative resuscitation; p = 0.23). Mortality rate was 1% (2 of 135 patients; both in GDT). On multivariable analysis, male sex, age, combined procedures, higher intraoperative fluid volume, and fluid boluses in the postanesthesia care unit were associated with higher 30-day morbidity. CONCLUSIONS: Stroke volume variation-guided GDT is safe in patients undergoing liver resection and led to less intraoperative fluid. Although the incidence of postoperative complications was similar in both arms, lower intraoperative resuscitation volume was independently associated with decreased postoperative morbidity in the entire cohort. Future studies should target extensive resections and identify patients receiving large resuscitation volumes, as this population is more likely to benefit from this technique. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/26206652/Goal_Directed_Fluid_Therapy_Using_Stroke_Volume_Variation_for_Resuscitation_after_Low_Central_Venous_Pressure_Assisted_Liver_Resection:_A_Randomized_Clinical_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(15)00272-0 DB - PRIME DP - Unbound Medicine ER -