Intraoperative circulatory management using the <scp>F</scp>lo<scp>T</scp>rac<sup>TM</sup> system in laparoscopic liver resection

Kitaguchi, Kazuhiko; Gotohda, Naoto; Yamamoto, Hiroyuki; Kato, Yukio; Takahashi, Shinichiro; Konishi, Masaru; Hayashi, Ryuichi

doi:10.1111/ases.12158

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…SVV has been proposed as a predictor of fluid responsiveness 28 but the threshold at which SVV should trigger fluid administration during major liver resection remains a matter of debate. The SVV target cut-off used in our study (13%) is much lower than that reported by other research groups, who used cut-offs of 18 to 21% 29,30 and advocated using a high SVV as a safe alternative to CVP monitoring during hepatic transection. Two studies have compared the effects of targeting a high SVV (10 to 20%) vs. a low SVV (<10%) during hepatic resection 31,32 .…”

Section: Discussioncontrasting

confidence: 57%

Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery

Chirnoaga

Coeckelenbergh

Ickx

et al. 2021

European Journal of Anaesthesiology

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Although fluid administration is a key strategy to optimise haemodynamic status and tissue perfusion, optimal fluid administration during liver surgery remains controversial. Low CVP is the clinical standard during liver surgery as it decreases blood loss and provides an optimal surgical field. GDFT aims to optimise SV and has been associated with a reduction in postoperative complications but may increase blood loss in liver surgery. A new urethral perfusion index is now available to assess peripheral tissue perfusion. In this randomised controlled trial of patients undergoing liver surgery, a GDFT strategy resulted in a higher mean urethral perfusion index than did a conventional fluid (low CVP) strategy and did not increase blood loss despite higher CVP.

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Section: Discussioncontrasting

confidence: 57%

Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery

Chirnoaga

Coeckelenbergh

Ickx

et al. 2021

European Journal of Anaesthesiology

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“…More recently however, SVV has been proposed as a minimally invasive and more accurate metric for the dynamic assessment of intravascular volume status. The maintenance of a SVV in the range of 10–20% during major hepatic resection surgery has been shown to correlate with a low CVP [16], and there is growing consensus that targeting a high SVV may be a safe alternative to fluid therapy guided by CVP measurements [16,17]. The SVV target cut off used in our study is aligned with other research groups who report that a CVP between −1 and 1 mmHg strongly correlates to an SVV of 18%–21%; these authors advocate for using a high SVV as a safe alternative to CVP monitoring during hepatic transection [16,17].…”

Section: Discussionmentioning

confidence: 99%

Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial

Weinberg

Ianno

Чурилов

et al. 2019

Annals of Medicine and Surgery

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Background The effect a restrictive goal directed therapy (GDT) fluid protocol combined with an enhanced recovery after surgery (ERAS) programme on hospital stay for patients undergoing major liver resection is unknown. Methods We conducted a multicentre randomized controlled pilot trial evaluating whether a patient-specific, surgery-specific intraoperative restrictive fluid optimization algorithm would improve duration of hospital stay and reduce perioperative fluid related complications. Results Forty-eight participants were enrolled. The median (IQR) length of hospital stay was 7.0 days (7.0:8.0) days in the restrictive fluid optimization algorithm group (Restrict group) vs. 8.0 days (6.0:10.0) in the conventional care group (Conventional group) (Incidence rate ratio 0.85; 95% Confidence Interval 0.71:1.1; p = 0.17). No statistically significant difference in expected number of complications per patient between groups was identified (IRR 0.85; 95%CI: 0.45–1.60; p = 0.60). Patients in the Restrict group had lower intraoperative fluid balances: 808 mL (571:1565) vs. 1345 mL (900:1983) (p = 0.04) and received a lower volume of fluid per kg/hour intraoperatively: 4.3 mL/kg/hr (2.6:5.8) vs. 6.0 mL/kg/hr (4.2:7.6); p = 0.03. No significant differences in the proportion of patients who received vasoactive drugs intraoperatively (p = 0.56) was observed. Conclusion In high-volume hepatobiliary surgical units, the addition of a fluid restrictive intraoperative cardiac output-guided algorithm, combined with a standard ERAS protocol did not significantly reduce length of hospital stay or fluid related complications. Our findings are hypothesis-generating and a larger confirmatory study may be justified.

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“…This value was set based on our considerations about SVV fluctuations in laparoscopic liver resection that we previously reported. 18 In actual intraoperative management, infusion volume was generally maintained at 2-4 mL/kg/h from start of anesthetic induction until completion of liver transection (the fluid restriction period). As a result, we achieved the target SVV (13%-20%) in all cases of the SVV group.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Intraoperative Fluid Management Using Stroke Volume Variation in Liver Resection

Kitaguchi

Gotohda

Yamamoto

et al. 2018

International Surgery

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The aim of this study is to examine whether intraoperative fluid management with stroke volume variation (SVV) can achieve safe intravenous fluid restriction and contribute to decreasing intraoperative blood loss in liver surgery. Background: In liver surgery, maintaining the central venous pressure (CVP) at a low level is effective in decreasing intraoperative blood loss. Recently, several studies have suggested that SVV obtained using the FloTrac system demonstrated a better fluid responsiveness than CVP. Methods: We enrolled 30 patients undergoing liver resection since May 2015 in this prospective observational study, and we set the SVV target during liver transection at 13%-20% (SVV group). Forty-three cases of liver resection that we performed between January 2014 and March 2015 without using CVP or SVV were used as the Control group. We compared the 2 groups by using intraoperative blood loss as the primary endpoint. Results: There was no significant difference in patient characteristics between the 2 groups. The mean SVV during liver transection in the SVV group was 15.6 6 4.4%. The infusion

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Intraoperative circulatory management using the FloTrac^TM system in laparoscopic liver resection

Cited by 8 publications

References 24 publications

Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery

Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery

Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial

A Comparative Study of Intraoperative Fluid Management Using Stroke Volume Variation in Liver Resection

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Intraoperative circulatory management using the FloTracTM system in laparoscopic liver resection

Cited by 8 publications

References 24 publications

Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery

Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery

Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial

A Comparative Study of Intraoperative Fluid Management Using Stroke Volume Variation in Liver Resection

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Product

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Intraoperative circulatory management using the FloTrac^TM system in laparoscopic liver resection