The Effect of Goal-directed Fluid Management based on Stroke Volume Variation on ICU Length of Stay in Elderly Patients Undergoing Elective Craniotomy: A Randomized Controlled Trial
Citation Information :
Sae-phua V, Tanasittiboon S, Sangtongjaraskul S. The Effect of Goal-directed Fluid Management based on Stroke Volume Variation on ICU Length of Stay in Elderly Patients Undergoing Elective Craniotomy: A Randomized Controlled Trial. Indian J Crit Care Med 2023; 27 (10):709-716.
Background: Inappropriate fluid management during neurosurgery can increase postoperative complications. In this study, we aimed to investigate the effect of goal-directed fluid therapy using stroke volume variation (SVV) in elderly patients undergoing elective craniotomy.
Materials and methods: We randomized 100 elderly patients scheduled for elective craniotomy into two groups: goal-directed therapy (GDT, n = 50) group and conventional group (n = 50). Fluid management protocol using SVV was applied in the GDT group. Decisions about fluid and hemodynamic management in the conventional group were made by the anesthesiologist. Perioperative variables including fluid balance, lactate level, and intensive care unit (ICU) length of stay were assessed.
Results: There was no significant difference in ICU length of stay between the two groups: 14 (12, 16.75) hours in GDT group vs 15 (13, 18) hours in control group (p = 0.116). Patients in the GDT group received a significantly less amount of crystalloid compared with the control group: 1311.5 (823, 2018) mL vs 2080 (1420, 2690) mL (p < 0.001). Our study demonstrated a better fluid balance in the GDT group as 342.5 (23, 607) mL compared with the conventional group 771 (462, 1269) mL (p < 0.001).
Conclusion: Intraoperative goal-directed fluid management based on SVV in elderly patients undergoing elective craniotomy did not reduce the ICU length of stay or postoperative complications. It did result in an improved fluid balance with no evidence of inadequate organ perfusion.
Clinical trial registration number: TCTR20190812003.
Lobo SM, Ronchi LS, Oliveira NE, Brandão PG, Froes A, Cunrath GS, et al. Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery. Crit Care 2011;15(5):R226. DOI: 10.1186/cc10466.
Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial. Ann Surg 2003;238(5):641–648. DOI: 10.1097/01.sla.0000094387.50865.23.
McArdle GT, McAuley DF, McKinley A, Blair P, Hoper M, Harkin DW. Preliminary results of a prospective randomized trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair. Ann Surg 2009;250(1):28–34. DOI: 10.1097/SLA.0b013e3181ad61c8.
De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care 2018;22(1):43. DOI: 10.1186/s13054-018-1959-3.
Cavallaro F, Sandroni C, Antonelli M. Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. Minerva Anestesiol 2008;74(4):123–35. PMID: 18212731.
Hofer CK, Müller SM, Furrer L, Klaghofer R, Genoni M, Zollinger A. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest 2005;128(2):848–854. DOI: 10.1378/chest.128.2.848.
Hofer CK, Senn A, Weibel L. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system. Crit Care 2008;12(3):R82. DOI: 10.1186/cc6933.
De Backer D, Cecconi M, Lipman J, Machado F, Myatra SN, Ostermann M, et al. Challenges in the management of septic shock: A narrative review. Intensive Care Med 2019;45(4):420–433. DOI: 10.1007/s00134-019-05544-x.
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40(12):1795–1815. DOI: 10.1007/s00134-014-3525-z.
Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 2011;112(6):1392–1402. DOI: 10.1213/ANE.0b013e3181eeaae5.
Biais M, Nouette-Gaulain K, Cottenceau V. Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. Br J Anaesth 2008;101(6):761–768. DOI: 10.1093/bja/aen277.
Button D, Weibel L, Reuthebuch O, Genoni M, Zollinger A, Hofer CK. Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth 2007;99(3):329–336. DOI: 10.1093/bja/aem188.
Senn A, Button D, Zollinger A, Hofer CK. Assessment of cardiac output changes using a modified FloTrac/Vigileo algorithm in cardiac surgery patients. Crit Care 2009;13(2):R32. DOI: 10.1186/cc7739.
Slagt C, Malagon I, Groeneveld AB. Systematic review of uncalibrated arterial pressure waveform analysis to determine cardiac output and stroke volume variation. Br J Anaesth 2014;112(4):626–637. DOI: 10.1093/bja/aet429.
Patel H, Parikh N, Shah R, Patel R, Thosani R, Shah P, et al. Effect of goal-directed hemodynamic therapy in postcardiac surgery patients. Indian J Crit Care Med 2020;24(5):321–326. DOI: 10.5005/jp-journals-10071-23427.
Mishra N, Rath GP, Bithal PK, Chaturvedi A, Chandra PS, Borkar SA. Effect of goal-directed intraoperative fluid therapy on duration of hospital stay and postoperative complications in patients undergoing excision of large supratentorial tumors. Neurol India 2022;70(1):108–114. DOI: 10.4103/0028-3886.336329.
Wu J, Ma Y, Wang T, Xu G, Fan L, Zhang Y. Goal-directed fluid management based on the auto-calibrated arterial pressure-derived stroke volume variation in patients undergoing supratentorial neoplasms surgery. Int J Clin Exp Med 2017;10(2):3106–3114. Available from: http://www.ijcem.com/files/ijcem004896.pdf.
Luo J, Xue J, Liu J, Liu B, Liu L, Chen G. Goal-directed fluid restriction during brain surgery: A prospective randomized controlled trial. Ann Intensive Care 2017;7(1):16. DOI: 10.1186/s13613-017-0239-8.
Zheng H, Guo H, Ye JR, Chen L, Ma H-P. Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: Randomized trial. World J Surg 2013;37(12):2820–2829. DOI: 10.1007/s00268-013-2203-6.
Tyagi A, Nagpal N, Sidhu DS. Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome. J Nat Sci Biol Med 2017;8(1):22–25. DOI: 10.4103/0976-9668.198342.
Amabili P, Wozolek A, Noirot I, Roediger L, Senard M, Donneau AF, et al. The edmonton frail scale improves the prediction of 30-day mortality in elderly patients undergoing cardiac surgery: A prospective observational study. J Cardiothorac Vasc Anesth 2019;33(4):945–952. DOI: 10.1053/j.jvca.2018.05.038.
Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 2001;92(4):984–989. DOI: 10.1097/00000539-200104000-00034.
Li J, Ji FH, Yang JP. Evaluation of stroke volume variation obtained by the FloTrac™/Vigileo™ system to guide preoperative fluid therapy in patients undergoing brain surgery. J Int Med Res 2012;40(3):1175–1181. DOI: 10.1177/147323001204000338.
Shaik Z, Mulam SS. Efficacy of stroke volume variation, cardiac output and cardiac index as predictors of fluid responsiveness using minimally invasive vigileo device in intracranial surgeries. Anesth Essays Res 2019;13(2):248–253. DOI: 10.4103/aer.AER_10_19.
Bloria SD, Panda NB, Jangra K, Bhagat H, Mandal B, Kataria K, et al. Goal-directed fluid therapy versus conventional fluid therapy during craniotomy and clipping of cerebral aneurysm: A prospective randomized controlled trial. J Neurosurg Anesthesiol 2022;34(4):407–414. DOI: 10.1097/ANA.0000000000000769.
Ramming S, Shackford SR, Zhuang J. The relationship of fluid balance and sodium administration to cerebral edema formation and intracranial pressure in a porcine model of brain injury. J Trauma 1994;37(5):705–713. DOI: 10.1097/00005373-199411000-00003.
Hasanin A, Mourad KH, Farouk I, Refaat S, Nabih A, Raouf SA, et al. The impact of goal-directed fluid therapy in prolonged major abdominal surgery on extravascular lung water and oxygenation: A randomized controlled trial. Open Access Maced J Med Sci 2019;7(8):1276–1281. DOI: 10.3889/oamjms.2019.173.
Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: Results of prospective randomized study. Crit Care 2010;14(3):R118. DOI: 10.1186/cc9070.