Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

Abstract

OBJECTIVES:This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies.METHODS:Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded.RESULTS:The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group.CONCLUSION:The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting) in thoracic surgery patients requiring one-lung ventilation.

Goal-directed fluid restriction using stroke volume variation and cardiac index during one-lung ventilation: a randomized controlled trial

“…Thus, we believe that SVV could be predictive of fluid responsiveness during OLV. Previous research shown that optimal threshold value of SVV to discriminate between fluid responders and non-responders during OLV was more than 10% (16,17). On the other hand, SVV less than 13% identifies fluid responder patients with high sensitivity and specificity (23,24).…”

“…Previous studies have demonstrated that SVV is useful to predict fluid responsiveness legitimately during OLV with acceptable levels of sensitivity and specificity (16,17). However, studies exploring the effect of intraoperative fluid restriction protocol based on advanced hemodynamic parameters on patients' oxygenation and postoperative prognosis during OLV are yet lacking.…”

Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

“…Currently, controversies exist concerning the reliability of static parameters of cardiac preload such as central venous pressure or pulmonary artery occlusion pressure monitoring in fluid management. Previous studies have shown that the use of dynamic parameters of cardiac preload for optimization of intraoperative fluid management could reduce morbidity 28,29. In addition, many studies have suggested that dynamic parameters of cardiac preload such as stroke volume variation or pulse pressure variation are more reliable predictors of fluid responsiveness during major surgery than static parameters 28,30.…”

“…Furthermore, Lee et al demonstrated that pulse pressure variation was a good predictor of fluid responsiveness during one-lung ventilation for thoracic surgery 31. A randomized controlled trial demonstrated that the use of stroke volume variation monitoring could significantly reduce intraoperative fluid replacement during one-lung ventilation compared with conventional fluid management 29. However, more studies are required to demonstrate the advantage of dynamic parameters during open chest conditions and one-lung ventilation.…”

Volume Management and Resuscitation in Thoracic Surgery

“…Thirdly, the volume of shunted blood through the non-ventilated lung should not contribute to the generation of SVV and PVV, necessitating a lower threshold value during OLV than that used during TLV [3, 85 • SVV has been used successfully to guide fluid therapy in thoracic surgery. A randomized study in thoracoscopic lobectomy found that the goal-directed therapy group, who received fluid boluses guided by SVV using the FloTracVigileo system, had higher PaO2/FiO2 ratios at the end of OLV, earlier extubation time, and received less overall fluid (1,385 ± 350 vs. 985 ± 135 mL) [87]. During esophagectomy, SVV accurately predicted hypovolemia, which was useful as a guide to appropriately time perioperative fluid therapy, and correlated better with cardiac output than CVP [88].…”