The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

Abstract

BACKGROUND: A growing interest had been paid to goal-directed fluid therapy (GDT) in abdominal surgery; however, its impact on the respiratory profile was not well investigated.
 AIM: We evaluated the impact of GDT on postoperative extravascular lung water and oxygenation after prolonged major abdominal surgery.
 METHODS: A randomised, controlled study was conducted in Kasr Alainy hospital from April 2016 till December 2017 including 120 adult patients scheduled for prolonged major abdominal surgery. Patients were randomised into either GDT group (n = 60) who received baseline restricted fluid therapy (2 mL/Kg/hour) which is guided by stroke volume variation, or control group (n = 60) who received standard care. Both study groups were compared according to hemodynamic data, fluid requirements, lung ultrasound score, and PaO2/fraction of inspired oxygen ratio (P/F ratio),
 RESULTS: Intraoperatively, GDT group received less volume of fluids and showed higher intraoperative mean arterial pressure compared to the control group. Postoperatively, lung ultrasound score was lower, and P/F ratio was higher in the GDT group compared to the control group. The number of patients who showed a significant postoperative increase in LUS was higher in the control group 44 (73%) patients versus 14 (23%) patients, P < 0.001).
 CONCLUSIONS: Using stroke volume variation for guiding fluid therapy in prolonged, major abdominal operations were associated with better hemodynamic profile, less intraoperative fluid administration, lower extravascular lung water and better oxygenation compared to standard care.

The Effect of Goal-Directed Fluid Therapy versus Standard Fluid Therapy on the Cuff Leak Gradient in Patients Undergoing Complex Spine Surgery in Prone Position

“…the effect of physiological fluid shift is minimal unlike abdominal surgeries which are characterized by third space loss and significant fluid shifts. 8,9 As such, tissue edema in our study is primarily a reflection of net fluid balance.…”

“…Our study correlates well with multiple other studies which have shown that GDFT results in lesser volume of fluid administered and lower net fluid balance, thus, causing less tissue edema. 8 9 However, our study differs in two main aspects. First, we utilized CLT for evaluating tissue edema unlike other studies which have utilized extravascular lung water for diagnosing tissue edema.…”

“…First, we utilized CLT for evaluating tissue edema unlike other studies which have utilized extravascular lung water for diagnosing tissue edema. 8,10 Second, our study included patients who underwent spine surgery where Table 1 Scoring system used for assessment of sore throat and hoarseness 7 Sore throat 0-No sore throat at any time since the operation 1-The patient answered in the affirmative when asked about sore throat (minimal sore throat) 2-The patient complained of sore throat on his/her own (moderate sore throat) 3-The patient is in obvious distress (severe sore throat) the effect of physiological fluid shift is minimal unlike abdominal surgeries which are characterized by third space loss and significant fluid shifts. 8,9 As such, tissue edema in our study is primarily a reflection of net fluid balance.…”

“…First, we utilized CLT for evaluating tissue edema unlike other studies which have utilized extravascular lung water for diagnosing tissue edema. 8 10 Second, our study included patients who underwent spine surgery where the effect of physiological fluid shift is minimal unlike abdominal surgeries which are characterized by third space loss and significant fluid shifts. 8 9 As such, tissue edema in our study is primarily a reflection of net fluid balance.…”

Pulse Pressure Variation-Guided Fluid Therapy during Supratentorial Brain Tumour Excision: A Randomized Controlled Trial

“…Pulse pressure variation (PPV) is one of the robust dynamic indices of fluid responsiveness which is based on heart-lung interactions [6]. GDT had been frequently investigated in the operating room in high-risk patients especially in major surgery [7], [8], [9]. However, the impact of GDT on patient outcomes, especially BRS, is not well evaluated in brain surgery.…”