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Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study

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Abstract

Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10 % and SV increase <10 % in response to fluid loading). Organ dysfunction was assessed using the SOFA score and resource utilization using the TISS score. Patients were followed up to 28 days for postoperative complications. Main outcome measures were the number of complications (infectious, cardiac, respiratory, renal, hematologic and abdominal post-operative complications), maximum SOFA score and cumulative TISS score during ICU stay, duration of mechanical ventilation, length of ICU stay, and time until fit for discharge. 12 patients had to be excluded from final analysis (6 in each group). During surgery, GDT received more colloids than CON (1,589 vs. 927 ml, P < 0.05) and SVV decreased in GDT (from 9.0 to 8.0 %, P < 0.05) but not in CON. The number of postoperative wound infections was lower in GDT (0 vs. 7, P < 0.01). Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction.

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Acknowledgments

The authors wish to thank Pascal Gandolfi for help in statistical analysis.

Conflict of interest

This work was supported by Edwards Lifesciences Corporation (sponsored research). All authors received honoraria for lectures from Edwards Lifesciences Corporation.

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Authors and Affiliations

  1. Department of Anaesthesiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    Thomas W. L. Scheeren

  2. Department of Anaesthesiology and Intensive Care, University Hospital Rostock, Rostock, Germany

    Thomas W. L. Scheeren

  3. Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany

    Christoph Wiesenack

  4. Department of Anaesthesiology, Intensive Care and Pain Therapy, Marienhospital, Gelsenkirchen, Germany

    Christoph Wiesenack

  5. Department of Anaesthesia, Intensive Care and Pain Therapy, Vivantes Klinikum Neukölln, Berlin, Germany

    Herwig Gerlach

  6. Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany

    Gernot Marx

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Correspondence to Thomas W. L. Scheeren.

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For commentary, please refer Niels H. Secher (doi: 10.1007/s10877-013-9462-5).

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Scheeren, T.W.L., Wiesenack, C., Gerlach, H. et al. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput 27, 225–233 (2013). https://doi.org/10.1007/s10877-013-9461-6

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