Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial

Bahlmann, Hans; Hahn, Robert G.; Nilsson, Lena

doi:10.1186/s12871-018-0579-4

Cited by 16 publications

(9 citation statements)

References 37 publications

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“…However, when compared to esophageal Doppler GDFT in patients requiring colorectal resection, a population more comparable to ours, fluid administration and outcome was not different [27]. Bahlmann et al also showed that PVI and stroke volume optimization assessed by esophageal Doppler during open abdominal surgery had similar outcome [28]. Our results parallel the latter studies and indicate that in low-to-moderate risk abdominal surgery, PVI seems to be an adequate guide for GDFT.…”

Section: Discussionsupporting

confidence: 80%

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

et al. 2019

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Background Goal-directed fluid therapy (GDFT) based on dynamic indicators of fluid responsiveness has been shown to decrease postoperative complications and hospital length of stay (LOS) in patients undergoing major abdominal surgery. The usefulness of this approach still needs to be clarified in low-to-moderate risk abdominal surgery. Both pulse-pressure variation (PPV) and pleth variability index (PVI) can be used to guide GDFT strategies. The objective of this prospective randomized controlled trial was to determine if the use of PVI guided GDFT, when compared to PPV guided GDFT, would lead to similar hospital LOS in patients undergoing low-to-moderate risk surgery. Secondary outcomes included amount of fluid administered and incidence of postoperative complications. Methods Patients were randomized into either PVI or PPV guided GDFT groups. Both received a baseline 2 ml kg − 1 h − 1 Lactated Ringer infusion. Additional fluid boluses consisted of 250 mL of colloid that was infused over a 10 min period if PVI was > 15% or PPV was > 13% for at least five minutes. The primary outcome was to determine if hospital LOS, which was defined as the number of days from surgery up to the day the surgeon authorized hospital discharge, was equivalent between the two groups. Results A total of 76 patients were included and they were randomized into two groups of 38 patients. Baseline characteristics were similar in both groups. Both PVI and PPV guided GDFT strategies were equivalent for the primary outcome of LOS (median [interquartile range]) (days) 2.5 [2.0–3.3] vs. 3.0 [2.0–5.0], p = 0.230, respectively. Fluids infused, postoperative complications, and all other outcomes were not different between groups. Conclusion In patients undergoing low-to-moderate risk abdominal surgery, PVI seems to guide GDFT similarly to PPV in regards to hospital LOS, amount of fluid, and incidence of postoperative complications. However, in low-risk patients undergoing these surgical procedures optimizing stroke volume may have limited impact on outcome. Trial registration ClinicalTrials.gov Identifier: NCT02908256 , September 2016, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12871-019-0707-9) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 80%

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

et al. 2019

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“…In this study, standard fluid management strategy was associated with elevated postoperative BUN, blood creatinine, and lactate levels, while fluid administration based on PVI monitoring did not cause any abnormal blood levels. Similarly, in other studies performed on non-geriatric patients it was demonstrated that fluid management under PVI guidance may reduce postoperative blood lactate levels [11,25,26]. Although they were primarily focused on the effects on the duration of hospitalization, the results of Fischer et al study offered opposite results: lactate levels were similar between PVI-guided and routine fluid management groups.…”

Section: Discussionmentioning

confidence: 84%

Geriyatrik cerrahi hastalarının intraoperatif sıvı yönetiminde pleth değişkenlik indeksinin potansiyel değeri

Ergün

Zengin

Bilgili

et al. 2022

Archives of Clinical and Experimental Medicine

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Aim: This study was designed to determine the effects of pleth variability index (PVI) guided monitoring on the optimal intravascular volume replacement during hip and knee arthroplasty in geriatric patients, and whether using PVI could reduce blood transfusion and vasopressor requirements. Methods: One-hundred geriatric patients who underwent elective hip and knee arthroplasty were included, assigned to either PVI group (volume replacement was PVI guided) or to a control group (volume replacement was based on traditional methods). Sealed envelope technique was used for randomization. Perioperative hemodynamic parameters, infusion rate of crystalloids, colloids, blood/blood products, ephedrine hydrochloride requirements and perioperative urine outputs were recorded. Results: Crystalloid infusion rate was higher (9.5 vs. 6.8 ml/kg/h, p<0.001) and ephedrine requirement was lower (2.0% vs. 38.0%, p<0.001) in group PVI. Postoperatively, the percentage of patients with high BUN, creatinine, and lactate levels were higher among controls (p<0.001). PVI group had significantly lower mean heart rate intraoperatively. Conclusions: Our findings suggest that intraoperative fluid replacement guided by PVI monitoring provides hemodynamic stability, preserves normal levels of BUN, creatinine, and lactate, and reduces unnecessary use of vasopressor agents in elderly surgical patients.

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“…Recently, Bahlmann et al compared PVI-based GDFM with esophageal Doppler-based stroke volume assessment in 146 subjects scheduled for open abdominal surgery. [ 25 ] Their results showed that PVI was non-inferior to the esophageal Doppler in terms of the rate of the post-operative complications, and length of hospital stay when used to direct the GDFM. Similar results were derived from the study of Cesur et al, which compared CFM with PVI-based GDFM in subjects undergoing elective colorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

PVI-based goal-directed fluid management in patients undergoing elective gynecologic surgery

Yılmaz¹

2021

Sisli Etfal

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Objectives Data concerning the usefulness of pleth variability index (PVI)-based goal-directed fluid management (GDFM) in gynecologic surgery is limited. This study purposed to compare the impact of PVI-based GDFM to conventional fluid management (CFM) on intraoperative hemodynamics and lactate levels in subjects undergoing gynecologic surgery. Methods This randomized and controlled trial was conducted on 70 patients undergoing elective gynecologic surgery. Subjects were randomly assigned to CFM or GDFM. Hemodynamic data and results of the arterial blood gas analysis, and total amount of the fluid infused were recorded throughout the surgery at 1-h intervals. Results The amount of the total fluids was significantly higher in the CFM group compared to that of the GDFM group (p<0.001). Mean arterial pressure recorded at the 2 nd h of the surgery was significantly lower in the CFM group compared to that of the GDFM group (p=0.047). While there were no significant differences between the baseline and the 2 nd h lactate levels in the GDFM group, the lactate level significantly increased from baseline to the 2 nd h in the CFM group (p=0.010). Conclusion Implementation of PVI-based GDFM provides better intraoperative hemodynamic stability and lower lactate levels compared to the CFM in subjects undergoing gynecologic surgery.

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Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial

Cited by 16 publications

References 37 publications

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

Geriyatrik cerrahi hastalarının intraoperatif sıvı yönetiminde pleth değişkenlik indeksinin potansiyel değeri

PVI-based goal-directed fluid management in patients undergoing elective gynecologic surgery

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