Prospective analysis of goal-directed fluid therapy vs conventional fluid therapy in perioperative outcome of composite resections of head and neck malignancy with free tissue transfer

Abstract

Background and Aim: Head and neck cancer surgeries with free tissue transfer are complex procedures, and fluid management can grossly affect the microvascular anastomosis. We hypothesise that intra-operative goal-directed fluid therapy (GDFT) is the key to administer fluid individualised to a patient's requirement. The aim of this study was to observe the role of GDFT in perioperative flap outcome and length of hospital stay. Methods: A randomised prospective controlled study was performed in 106 patients undergoing composite resection of head and neck cancer with free tissue transfer. Patients in Group A received GDFT based on stroke volume variation whereas Group B received conventional fluid therapy intra-operatively. The endpoints of this study were total perioperative fluid, fluid boluses, vasopressor requirement, flap outcome and length of intensive care unit and hospital stay. Statistical analysis was done using Chi-square test. Results: The total intra-operative fluid given to both the groups was comparable but patients in Group A received more boluses and vasopressors compared to Group B during intra-operative period. The amount of fluid given in the first 24 hours post-operatively was significantly less in Group A (1807 + 476 ml) compared to Group B (2205 + 382 ml). Incidence of hypotension with tachycardia was observed in three patients in Group B and none in Group A. Poor flap outcome was observed in one patient in Group A versus four in Group B due to thrombosis. Conclusion: GDFT helps in early detection of fluid deficit and may avoid complications arising due to inadequate microvascular perfusion during the peri-operative period.

Effect of machine learning‐guided haemodynamic optimization on postoperative free flap perfusion in reconstructive maxillofacial surgery: A study protocol

“…In the intervention group, intraoperative fluid administration was guided by advanced haemodynamic monitoring, while in the control group, it was guided by classical MAP target values. Patients in the intervention group received significantly less fluids in the first 24 h after surgery 26 …”

“…25 With the need for the better haemodynamic therapy, advanced haemodynamic monitoring with GDHT was implemented. 26 Lahtinen et al published a study in which they showed that administration of fluids according to SVV values intraoperatively reduced the total administered volume of fluids in patients during the first 24 h (6070 vs. 8185 mL, P < .001) and that the hospital stay was shorter (11.5 vs. 14.0 days, P = .024) as well as the duration of the tracheostomy (7 vs. 9.5 days, P = .001). 27 Also, Kim et al, in a similar prospective study on 62 patients showed better flap survival, a smaller amount of crystalloids given and a shorter stay in ICU in patients with GDHT.…”

Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis

“…Aaen et al (24) Denmark Emergency surgery for intestinal obstruction or gastrointestinal perforation in adult patients Cecconi et al (25) Italy Patients undergoing hip arthroplasty surgery Colantonio et al (26) Italy ASA II-III patients diagnosed with peritoneal carcinomatosis candidates for peritonectomy and HIPEC Gupta et al (27) India Patients undergoing resection of head and neck cancer with tissue transfer Hand et al (28) United States Adult patients with tissue transfer surgery for primary reconstruction with head and neck oncological surgeons Kapoor et al (29) India Patients undergoing saphenous vein graft surgery with EuroSCORE greater than or equal to 3…”

Women Undergoing Goal-Directed Fluid Therapy During Pregnancy: A Systematic Review and Meta-Analysis of Published Randomized Controlled Trials

“…GDFT is guided by dynamic indicators such as pulse pressure variation and stroke volume variation (SVV) to predict fluid responsiveness [5] . Also, techniques like arterial waveform-based analysis, pulmonary artery catheterization, echocardiography, and thoracic bioimpedance-based technologies are needed for the assessment of volume status [6] .…”