scholarly journals Goal-Directed Fluid Therapy Based on Stroke Volume Variations Improves Fluid Management and Gastrointestinal Perfusion in Patients Undergoing Major Orthopedic Surgery

2014 ◽  
Vol 23 (5) ◽  
pp. 413-420 ◽  
Author(s):  
Ke Peng ◽  
Jian Li ◽  
Hao Cheng ◽  
Fu-hai Ji
Keyword(s):  
Stroke Volume ◽  
Fluid Therapy ◽  
Orthopedic Surgery ◽  
Fluid Management ◽  
Major Orthopedic Surgery ◽  
Goal Directed Fluid Therapy ◽  
Stroke Volume Variations

scholarly journals Goal-directed versus Standard Fluid Therapy to Decrease Ileus after Open Radical Cystectomy

2020 ◽  
Vol 133 (2) ◽  
pp. 293-303
Author(s):  
Vittoria Arslan-Carlon ◽  
Kay See Tan ◽  
Guido Dalbagni ◽  
Alessia C. Pedoto ◽  
Harry W. Herr ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Radical Cystectomy ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Fluid Management ◽  
Fluid Administration ◽  
Secondary Outcome ◽  
Post Surgery ◽  
Goal Directed Fluid Therapy ◽  
Open Radical Cystectomy

Background Postoperative ileus is a common complication of intraabdominal surgeries, including radical cystectomy with reported rates as high as 32%. Perioperative fluid administration has been associated with improvement in postoperative ileus rates, but it is difficult to generalize because earlier studies lacked standardized definitions of postoperative ileus and other relevant outcomes. The hypothesis was that targeted individualized perioperative fluid management would improve postoperative ileus in patients receiving radical cystectomy. Methods This is a parallel-arm, double-blinded, single-center randomized trial of goal-directed fluid therapy versus standard fluid therapy for patients undergoing open radical cystectomy. The primary outcome was postoperative ileus, and the secondary outcome was complications within 30 days post-surgery. Participants were at least 21 yr old, had a maximum body mass index of 45 kg/m2 and no active atrial fibrillation. The intervention in the goal-directed therapy arm combined preoperative and postoperative stroke volume optimization and intraoperative stroke volume variation minimization to guide fluid administration, using advanced hemodynamic monitoring. Results Between August 2014 and April 2018, 283 radical cystectomy patients (142 goal-directed fluid therapy and 141 standard fluid therapy) were included in the analysis. Postoperative ileus occurred in 25% (36 of 142) of patients in the goal-directed fluid therapy arm and 21% (30 of 141) of patients in the standard arm (difference in proportions, 4.1%; 95% CI, −5.8 to 13.9; P = 0.418). There was no difference in incidence of high-grade complications between the two arms (20 of 142 [14%] vs. 23 of 141 [16%]; difference in proportions, −2.2%; 95% CI, −10.6 to 6.1; P = 0.602), with the exception of acute kidney injury, which was more frequent in the goal-directed fluid therapy arm (56% [80 of 142] vs. 40% [56 of 141] in the standard arm; difference in proportions, 16.6%; 95% CI, 5.1 to 28.1; P = 0.005; P = 0.170 after adjustment for multiple testing). Conclusions Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Wet or Dry?

2017 ◽  
Vol 35 (1) ◽  
pp. 221-239
Author(s):  
Matthew D'Angelo ◽  
R. Kyle Hodgen
Keyword(s):  
Fluid Therapy ◽  
Fluid Management ◽  
Tissue Perfusion ◽  
Knowledge Generation ◽  
Algorithmic Approach ◽  
Science And Culture ◽  
Goal Directed Fluid Therapy ◽  
Near Future ◽  
Perioperative Fluid Therapy ◽  
Patient Centric

Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient. The future of perioperative IVF therapy will be patient centric. In the near future, anesthetists will know the patient's blood volume before, during, and after the surgery. They will no longer depend on inaccurate surrogates to estimate, but have the knowledge to titrate fluids to maintain a zero balance. Practice will move away from algorithms and toward individualized fluid administration based on reproducible end points. Decisions about fluid selection, timing, and volume will be driven by patient- and case-specific requirements as specific as when a patient is typed and crossed for blood transfusion. The greatest challenge for the anesthetist in perioperative fluid therapy is to move beyond the dogmatic practices of the past and toward fluid therapy guided by patient centric evidence.

Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position

Spine ◽  
2016 ◽  
Vol 41 (18) ◽  
pp. E1131-E1137 ◽  
Author(s):  
Maria Renata Bacchin ◽  
Chiara Marta Ceria ◽  
Sandra Giannone ◽  
Daniela Ghisi ◽  
Gaetano Stagni ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Prone Position ◽  
Spine Surgery ◽  
Fluid Therapy ◽  
Stroke Volume Variation ◽  
Volume Variation ◽  
Goal Directed Fluid Therapy

scholarly journals Efficacy of Goal-Directed Fluid Therapy Monitored by Pulse-Pressure Variation Using a C ontinuous Non-Invasive Arterial Pressure Monitoring System (the CNAPTM System) During Parathyroidectomy in Patients with End-Stage Renal Failure - A randomized trial

2019 ◽  
Author(s):  
Jie Song ◽  
Xiaofen Liu ◽  
Weiwei Jiang ◽  
Jiayou Wang ◽  
Yun Li ◽  
...  
Keyword(s):  
Renal Failure ◽  
Arterial Pressure ◽  
Fluid Therapy ◽  
Normal Saline ◽  
Fluid Management ◽  
Pressure Variation ◽  
End Stage Renal Failure ◽  
Intraoperative Period ◽  
Goal Directed Fluid Therapy ◽  
End Stage

Abstract Background: There are no well-recognized guidelines for intraoperative fluid management in patients with end-stage renal failure (ESRF) . Goal-directed fluid therapy (GDFT) is a concept of perioperative fluid management that improves patients’ prognosis. Dynamic indicators better predict fluid response than static indicators. Aim: In this study, we assessed a GDFT protocol with monitoring of pulse pressure variation (PPV) in patients with ESRF undergoing parathyroidectomy. Methods: The study included 102 patients who underwent elective parathyroidectomy. They were randomized to a control group (restrictive group, n = 51) that was managed with a restricted fluid regimen or a PPV group (GDFT group, n = 51) that was given a normal saline infusion and was monitored for change in PPV during the intraoperative period. If PPV reached >13%, 250 mL normal saline was administered over 15 min. Ephedrine was given at increments of 6 mg to keep mean arterial pressure >65 mmHg . Hemodynamic variables in the perioperative period were recorded. The primary endpoint was the occurrence of postoperative hypotension. Results: The occurrence of postoperative hypotension in the GDFT group was lower than in the restrictive group (0 vs. 11.67%, P = 0.027). The patients with complications in the GDFT group was lower than in the restrictive group (35.3% vs. 54.9%, P = 0.047). The volume of saline infused during the intraoperative period was 364 (219-408) mL in the GDFT group and 50 (50-50) mL in the restrictive group ( P = 0.001). Ephedrine was given to 16/51 (29.4%) of the GDFT group and 27/51 (52.9%) of the restrictive group ( P = 0.027). Conclusion: The use of goal-directed fluid therapy with the dynamic PPV indicator in patients with ESRF undergoing parathyroidectomy guides the administration of infused fluids, with reduced incidence of postoperative hypotension.

scholarly journals Blood Metabolomic Profiling Predicts Postoperative Gastrointestinal Function Of Colorectal Surgical Patients Under The Guidance Of Goal-Directed Fluid Therapy

2020 ◽  
Author(s):  
Tao Xie ◽  
Zhengyu Jiang ◽  
Cen Wen ◽  
Du Shen ◽  
Jinjun Bian ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Fluid Therapy ◽  
Fluid Management ◽  
Postoperative Recovery ◽  
Postanesthesia Care Unit ◽  
Support Vector ◽  
Gastrointestinal Function ◽  
Machine Model ◽  
Metabolomic Profiling ◽  
Goal Directed Fluid Therapy

Abstract Background: Postoperative gastrointestinal function influences postoperative recovery and hospital stay length for patients undergoing colorectal surgery. Goal-directed fluid therapy (GDFT) restricts fluid administration to an amount required to prevent dehydration. Although the fluid management of GDFT could decrease the incidence of postoperative complications in patients who undergo high-risk surgery, certain patients may not respond to GDFT. Thus, to achieve optimal treatment, identification of patients suitable for GDFT is necessary. Accordingly, in this study, we evaluated the predictive capacity of metabolomics profiling for postoperative recovery after surgery for colorectal cancer.Methods: Metabolomic profiling of 48 patients with colorectal cancer who underwent surgery was performed. Patients were divided into delayed- and enhanced-recovered groups based on gastrointestinal function within 72 hours, and the results of -omics analysis showed differential serum metabolites between the two groups of patients in the postanesthesia care unit 24 hours after surgery. A support vector machine model was applied to evaluate the curative effects of GDFT in different patients.Results: Four metabolites, oleamide, ubiquinone-1, acetylcholine, and oleic acid, were found to be highly associated with postoperative gastrointestinal function and could serve as potential biomarkers. Moreover, four pathways were found to be highly related to postoperative gastrointestinal recovery. Among these, the vitamin B6 metabolism pathway may be a common pathway for improving postoperative recovery in various diseases.Conclusion: Our findings proposed a novel method to predict postoperative recovery of gastrointestinal function based on metabolomic profiling and suggested the potential mechanisms contributing to gastrointestinal function after surgical resection of colorectal cancer under the fluid management of GDFT. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800015899, Registered 27 April 2018, http://www.chictr.org.cn/showproj.aspx?proj=26623

scholarly journals Intra-Operative IV Fluid Management: Goal Directed Therapy with Esophageal Doppler Monitoring vs. Standard Weight Based Fluid Therapy

2016 ◽  
Author(s):  
Amanda Krueger
Keyword(s):  
Length Of Stay ◽  
Stroke Volume ◽  
Fluid Therapy ◽  
Fluid Management ◽  
Rectal Surgery ◽  
Management Technique ◽  
Esophageal Doppler ◽  
Goal Directed Therapy ◽  
Individualized Approach ◽  
The Impact

<p>Intravenous fluid management in the peri-operative period continues to be a debate in the anesthesia literature in terms of which fluid type is best along with how much fluid should be given. The majority of post-operative complications in colo-rectal surgery can be traced back to the amount of IV fluids patients receive. Most recently the term Goal- directed therapy (GDT) states that a more individualized approach to fluid management is not only safer but necessary. The Esophageal Doppler, a technology analyzing stroke volume and cardiac output intra-operative, may prove to be a safe way to provide GDT and decrease complications post-operatively. This systematic review examined the impact of the esophageal Doppler versus the traditional weight based fluid management technique on adult (>18 years of age) patient outcomes post-operatively after colo-rectal and abdominal surgery. The goal was to highlight best practices that will decrease adverse patient events and length of stay (LOS). Four out of the five randomized controlled trials analyzed for this review do report that ED use and GDT decrease complications and ICU admissions post-operatively versus utilizing a more standard approach to fluid management. Due to other social variables in discharging subjects, length of stay was not found to be decreased in GDT subject groups. In furthering anesthesia practice, standard fluid management techniques should be updated with a more individualized approach focusing on patient variables such as stroke volume and what the response is to fluid therapy intra-operatively.</p>

scholarly journals Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Shan-Han Yang ◽  
Yi-Shiuan Lin ◽  
Chien-Nan Lee ◽  
Ya-Jung Cheng ◽  
Ying-Hsi Chen ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Stroke Volume ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Fluid Therapy ◽  
Fluid Challenge ◽  
Fixed Dose ◽  
Control Group ◽  
Crystalloid Fluid ◽  
Goal Directed Fluid Therapy

Background. Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation. Method. In total, 71 consecutive full-term pregnant women were randomly divided into a control group ( n = 34 ) and a GDFT group ( n = 37 ). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles. Result. Women in the GDFT group received more fluid than did those in the control group ( 1132 ± 108 vs. 1247 ± 202  mL; p = 0.0044 ), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864 ) and norepinephrine dose ( 12.5 ± 10.6 vs. 15.1 ± 12.8  mcg, respectively; p = 0.3512 ) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332 ). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups. Conclusion. ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.

scholarly journals Goal-Directed Fluid Therapy Using Stroke Volume Variation Does Not Result in Pulmonary Fluid Overload in Thoracic Surgery Requiring One-Lung Ventilation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Sebastian Haas ◽  
Volker Eichhorn ◽  
Ted Hasbach ◽  
Constantin Trepte ◽  
Asad Kutup ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Fluid Therapy ◽  
Stroke Volume Variation ◽  
Fluid Overload ◽  
Fluid Management ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Goal Directed Fluid Therapy ◽  
Lateral Thoracotomy ◽  
Observation Period

Background. Goal-directed fluid therapy (GDT) guided by functional parameters of preload, such as stroke volume variation (SVV), seems to optimize hemodynamics and possibly improves clinical outcome. However, this strategy is believed to be rather fluid aggressive, and, furthermore, during surgery requiring thoracotomy, the ability of SVV to predict volume responsiveness has raised some controversy. So far it is not known whether GDT is associated with pulmonary fluid overload and a deleterious reduction in pulmonary function in thoracic surgery requiring one-lung-ventilation (OLV). Therefore, we assessed the perioperative course of extravascular lung water index (EVLWI) and -ratio during and after thoracic surgery requiring lateral thoracotomy and OLV to evaluate the hypothesis that fluid therapy guided by SVV results in pulmonary fluid overload.Methods. A total of 27 patients (group T) were enrolled in this prospective study with 11 patients undergoing lung surgery (group L) and 16 patients undergoing esophagectomy (group E). Goal-directed fluid management was guided by SVV (SVV < 10%). Measurements were performed directly after induction of anesthesia (baseline—BL), 15 minutes after implementation OLV (OLVimpl15), and 15 minutes after termination of OLV (OLVterm15). In addition, postoperative measurements were performed at 6 (6postop), 12 (12postop), and 24 (24postop) hours after surgery. EVLWI was measured at all predefined steps. The -ratio was determined at each point during mechanical ventilation (group L: BL-OLVterm15; group E: BL-24postop).Results. In all patients (group T), there was no significant change in EVLWI during the observation period (BL: 7.8 ± 2.5, 24postop: 8.1 ± 2.4 mL/kg). A subgroup analysis for group L and group E also did not reveal significant changes of EVLWI. The -ratio decreased significantly during the observation period (group L: BL: 462 ± 140, OLVterm15: 338 ± 112 mmHg; group E: BL: 389 ± 101, 24postop: 303 ± 74 mmHg) but remained >300 mmHg except during OLV.Conclusions. SVV-guided fluid management in thoracic surgery requiring lateral thoracotomy and one-lung ventilation does not result in pulmonary fluid overload. Although oxygenation was reduced, pulmonary function remained within a clinically acceptable range.

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