Outcomes associated with stroke volume variation versus central venous pressure guided fluid replacements during major abdominal surgery

Abstract

Background and Aims:There is limited data on the impact of perioperative fluid therapy guided by dynamic preload variables like stroke volume variation (SVV) on outcomes after abdominal surgery. We studied the effect of SVV guided versus central venous pressure (CVP) guided perioperative fluid administration on outcomes after major abdominal surgery.Material and Methods:Sixty patients undergoing major abdominal surgeries were randomized into two equal groups in this prospective single blind randomized study. In the standard care group, the CVP was maintained at 10-12 mmHg while in the intervention group a SVV of 10% was achieved by the administration of fluids. The primary end-points were the length of Intensive Care Unit (ICU) and hospital stay. The secondary end points were intraoperative lactate, intravenous fluid use, requirement for inotropes, postoperative ventilation and return of bowel function.Results:The ICU stay was significantly shorter in the intervention group as compared to the control group (2.9 ± 1.15 vs. 5.4 ± 2.71 days). The length of hospital stay was also shorter in the intervention group, (9.9 ± 2.68 vs. 11.96 ± 5.15 days) though not statistically significant. The use of intraoperative fluids was significantly lower in the intervention group than the control group (7721.5 ± 4138.9 vs. 9216.33 ± 2821.38 ml). Other secondary outcomes were comparable between the two groups.Conclusion:Implementation of fluid replacement guided by a dynamic preload variable (SVV) versus conventional static variables (CVP) is associated with lesser postoperative ICU stay and reduced fluid requirements in major abdominal surgery.

Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis

“…Of 19,664 citations retrieved, we included 13 unique trials enrolling 1,652 patients ( Fig. 1 and Table 1 ) ( 21 , 23 – 34 ). All included trials were published articles in English-language peer-reviewed journals.…”

“…The ICU population was characterized by nine trials that enrolled patients undergoing high risk intra-abdominal surgery ( 21 , 23 , 26 , 27 , 29 , 30 , 32 – 34 ), three trials of cardiac surgery patients ( 24 , 25 , 31 ), and one trial of patients with septic shock ( 28 ). Ten of 13 included trials prohibited the enrollment of patients with dysrhythmias or atrial fibrillation ( 21 , 23 – 26 , 29 , 31 – 34 ). Seven trials mandated a lower limit of tidal volume of 8 cc/kg during mechanical ventilation ( 23 – 26 , 29 , 30 , 33 ).…”

“…Criteria used for determining fluid responsiveness included assessment of SVV with threshold greater than 10–15% in nine trials ( 23 – 25 , 29 – 34 ), assessment of PPV with threshold greater than 10% in one trial ( 26 ), and the use of passive leg raise or mini fluid challenge with threshold of an increase in SV of 10% in three trials ( 21 , 27 , 28 ). Cointerventions and additional goal-directed therapy targets are itemized in Table 1 .…”

“…Cointerventions and additional goal-directed therapy targets are itemized in Table 1 . In control groups, patients were managed with traditional goal-directed therapy algorithms targeting static variables including the CVP in nine trials ( 21 , 24 , 25 , 27 , 28 , 31 – 34 ), weight-based fluid loading in one trial ( 30 ), and standard care per treatment team in three trials ( 23 , 26 , 29 ). The protocolized fluid was colloid of any type in five trials ( 21 , 25 , 27 , 32 , 33 ), hydroxyethyl starch in three trials ( 24 , 26 , 29 ), and either crystalloid or physician choice in five trials ( 23 , 28 , 30 , 31 , 34 ).…”

“…In control groups, patients were managed with traditional goal-directed therapy algorithms targeting static variables including the CVP in nine trials ( 21 , 24 , 25 , 27 , 28 , 31 – 34 ), weight-based fluid loading in one trial ( 30 ), and standard care per treatment team in three trials ( 23 , 26 , 29 ). The protocolized fluid was colloid of any type in five trials ( 21 , 25 , 27 , 32 , 33 ), hydroxyethyl starch in three trials ( 24 , 26 , 29 ), and either crystalloid or physician choice in five trials ( 23 , 28 , 30 , 31 , 34 ). The intervention was delivered in the operating room (OR) prior to ICU admission in six trials ( 23 , 26 , 29 , 32 – 34 ), the OR and ICU in four trials ( 24 , 25 , 27 , 30 ), and the ICU only in three trials ( 21 , 28 , 31 ).…”