Abstract:BACKGROUND: Goal-directed fluid therapy (GDFT) improved patient outcomes in various surgical procedures; however, its role during mass brain resection was not well investigated.
AIM: In this study, we evaluated a simple protocol based on intermittent evaluation of pulse pressure variation for guiding fluid therapy during brain tumour resection.
METHODS: Sixty-one adult patients scheduled for supratentorial brain mass excision were randomized into either GDFT group (received intraoperative fluids gu… Show more
“…Between the CVP group, which maintained a CVP of 5-10 cm-H2O, and the PPV group, which maintained a PPV below 13%, in patients undergoing a brain tumor surgery, the latter had better postoperative hemodynamic stability and less postoperative fluid requirement [69]. The PPV-guided GDFT during supratentorial tumor resection had a comparable brain relaxation scale, low serum lactate levels, more intra-operative fluids, and higher urine output than the standard care group [70]. In the sitting position for neurosurgery, measuring the PPV and PVI with an ear sensor predicted fluid responsiveness well, but the PVI could not be predicted with a finger sensor.…”
Section: Gdft During Neurosurgerymentioning
confidence: 93%
“…The PPV and PVI have also been reported to be good predictors of fluid reactivity during brain surgery [69][70][71][72]. Between the CVP group, which maintained a CVP of 5-10 cm-H2O, and the PPV group, which maintained a PPV below 13%, in patients undergoing a brain tumor surgery, the latter had better postoperative hemodynamic stability and less postoperative fluid requirement [69].…”
Fluid management is an important component of perioperative care for patients undergoing neurosurgery. The primary goal of fluid management in neurosurgery is the maintenance of normovolemia and prevention of serum osmolarity reduction. To maintain normovolemia, it is important to administer fluids in appropriate amounts following appropriate methods, and to prevent a decrease in serum osmolarity, the choice of fluid is essential. There is considerable debate about the choice and optimal amounts of fluids administered in the perioperative period. However, there is little high-quality clinical research on fluid therapy for patients undergoing neurosurgery. This review will discuss the choice and optimal amounts of fluids in neurosurgical patients based on the literature, recent issues, and perioperative fluid management practices.
“…Between the CVP group, which maintained a CVP of 5-10 cm-H2O, and the PPV group, which maintained a PPV below 13%, in patients undergoing a brain tumor surgery, the latter had better postoperative hemodynamic stability and less postoperative fluid requirement [69]. The PPV-guided GDFT during supratentorial tumor resection had a comparable brain relaxation scale, low serum lactate levels, more intra-operative fluids, and higher urine output than the standard care group [70]. In the sitting position for neurosurgery, measuring the PPV and PVI with an ear sensor predicted fluid responsiveness well, but the PVI could not be predicted with a finger sensor.…”
Section: Gdft During Neurosurgerymentioning
confidence: 93%
“…The PPV and PVI have also been reported to be good predictors of fluid reactivity during brain surgery [69][70][71][72]. Between the CVP group, which maintained a CVP of 5-10 cm-H2O, and the PPV group, which maintained a PPV below 13%, in patients undergoing a brain tumor surgery, the latter had better postoperative hemodynamic stability and less postoperative fluid requirement [69].…”
Fluid management is an important component of perioperative care for patients undergoing neurosurgery. The primary goal of fluid management in neurosurgery is the maintenance of normovolemia and prevention of serum osmolarity reduction. To maintain normovolemia, it is important to administer fluids in appropriate amounts following appropriate methods, and to prevent a decrease in serum osmolarity, the choice of fluid is essential. There is considerable debate about the choice and optimal amounts of fluids administered in the perioperative period. However, there is little high-quality clinical research on fluid therapy for patients undergoing neurosurgery. This review will discuss the choice and optimal amounts of fluids in neurosurgical patients based on the literature, recent issues, and perioperative fluid management practices.
“…When MAP remained < 60 mmHg despite the fluid intervention or MAP was < 60 mmHg with PPV ≤ 14% and SV increased less than 10%, vasopressor therapy was initiated, in the form of an ephedrine bolus of 6 mg with a maximal cumulative dose of 30 mg. If needed, a continuous infusion of norepinephrine (0.05 μg·kg -1 ·min -1 ) was administered (Hasanin et al 2019 ). Fig.…”
Background
Postoperative delirium (POD) is a common phenomenon after spinal surgery. Intraoperative fluid management may affect POD. The aim of this study was to compare the effects of restrictive fluid therapy (RF) with those of goal-directed fluid therapy (GDT) on POD.
Methods
A total of 195 patients aged ≥ 50 years who underwent spinal surgery were randomly divided into two groups: the RF group and the GDT group. In group RF, a bolus of lactated Ringer’s solution was administered at a dose of 5 mL·kg-1 before the induction of anesthesia, followed by a dose of 5 mL·kg-1·h-1 until the end of surgery. For patients in the GDT group, in addition to the initial administration of lactated Ringer’s solution at 5 mL·kg-1, the subsequent fluid therapy was adjusted by using a continuous noninvasive arterial pressure (CNAP) monitoring system to maintain pulse pressure variation (PPV) ≤ 14%. The primary endpoint was the incidence of POD, assessed once daily with the Confusion Assessment Method-Chinese Reversion (CAM-CR) scale at 1–3 days postoperatively. The secondary endpoints were intraoperative fluid infusion volume, urine volume, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), regional cerebral oxygen saturation (rSO2) value, lactic acid value, and visual analog scale (VAS) pain score at 1–3 days after surgery. Moreover, postoperative complications and the length of hospital stay were recorded.
Results
The incidence of POD was lower in the GDT group than in the RF group (12.4% vs 4.1%; P = 0.035) in the first 3 days after spine surgery. Compared to group RF, group GDT exhibited a significantly increased volume of intraoperative lactated Ringer’s solution [1500 (interquartile range: 1128 to 1775) mL vs 1000 (interquartile range: 765 to 1300) mL, P < 0.001] and urine volume [398 (interquartile range: 288 to 600) mL vs 300 (interquartile range: 200 to 530) mL, P = 0.012]. Intraoperative MAP, CI and rSO2 values were higher in the GDT group than in the RF group (P < 0.05). Moreover, the length of hospital stay [17.0 (14 to 20) days versus 14.5 (13 to 17.0) days, P = 0.001] was shorter in the GDT group than in the RF group.
Conclusions
GDT reduced the incidence of POD in middle- and old-aged patients undergoing spinal surgery possibly by stabilizing perioperative hemodynamic and improving the supply and demand of oxygen.
Trial registration
ChiCTR2000032603; Registered on May 3, 2020.
“…To the best of our knowledge, very few studies have suggested the efficacy of PPV in the neurosurgical population. [11][12][13][14] Hence, this study aimed to compare the effect of PPVguided fluid management with the conventional CVP-guided method in patients undergoing supratentorial tumor surgeries. The primary outcome was to compare the intraoperative fluid requirement between CVP-and PPV-guided management.…”
Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries.
Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed.
Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables.
Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups.
Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.
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