Goal-directed therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective observational study

Abstract

There is a great variability in the intraoperative fluid therapy needs of the patients. SVV monitoring makes it possible to adjust the fluid therapy needs in each surgery phase. The use of a hemodynamic goal-directed anesthetic protocol in CRS and HIPEC enables to individually adjust the fluid therapy, avoiding over-hydration and ensuring hemodynamic stability in all surgery phases.

Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management

“…In addition, since extensive fluid shifts occur during the cytoreductive phase, and hyperthermia leads to vasodilation and a hyperdynamic circulation with an increase in heart rate, close monitoring of central venous pressure and cardiac index during the HIPEC phase is required. Standard methods for haemodynamic monitoring of cardiac output and stroke volume variation (SVV) are recommended to guide goal directed fluid therapy [149,150] and are described further in section 14. An arterial line is an important monitor to guide vasoactive drug use and arterial blood gas sampling.…”

Complications and Mortality Rate of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: Italian Peritoneal Surface Malignancies Oncoteam Results Analysis

“…Although these physiologic perturbations inherent to the procedure represent a significative perioperative challenge, to date no standard guidelines exist concerning intraoperative management. The use of goal-directed therapy enables to individually adjust the fluid therapy, avoiding over-hydration and ensuring hemodynamic stability of patients, resulting in lower morbidity and mortality rates, as well as length of hospital stay [ 54 , 55 , 56 , 57 ]. The procedure often includes complex, multivisceral resections and blood loss is significant in the great majority of patients.…”

The Effect Of Intraoperative Restrictive Fluid Therapy On Postoperative Outcomes In Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy

“…Tanı kriterlerinde büyük değişikliklerle birlikte, HIPEK ilişkili akut böbrek hasarı (ABH) oranı %0-18.6 arasında tanımlanmaktadır (24) . SRC aşamasında 0.5-1 mL kg -1 sa -1 idrar çıkışı yeterliyken (25) , HİPEK aşamasında idrarın saatlik 400 mL olması önerilmektedir (6,7) . Literatürde hipotansiyon ve inotropik ilaçlardan kaçınılarak >2 mL kg sa -1 idrar çıkışının HİPEK sonrası böbrek hasarını önlemede yeterli olduğu belirtilmiştir (26) .…”