The concept of titration can be transposed to fluid management. but does is change the volumes? randomised trial on pleth variability index during fast-track colonic surgery.
[en] BACKGROUND: The concept of drug titration emerged recently for intraoperative fluid administration during Fast-Track colonic surgery to avoid hypovolemia as well as excessive crystalloid administration. The Pleth Variability Index (PVI) is an oximeter-derived parameter. It allows a continuous monitoring of the respiratory variation of the perfusion index. OBJECTIVE: To investigate if applying the concept of fluid titration with PVI-guided colloid administration conjointly with restricted crystalloids administration changes the amount of fluid administered. DESIGN, SETTINGS AND PATIENTS: Twenty one ASA 2 patients scheduled for Fast-Track colonic surgery were randomized in two groups: the PVI-guided the fluid management group and the the control group. INTERVENTION AND MAIN OUTCOME MEASURES: After the induction of general anesthesia, the PVI group received a 10 mL.kg- 1.h-1 infusion of crystalloid during the first hour, reduced to 2 mL.kg-1.h-1 thereafter. Colloids 250 mL were administered if necessary to maintain a PVI value of 10 to 13%. In the control group, a 10 mL.kg-1.h-1 infusion of crystalloid during the first hour was followed by a 5 mL.kg-1.h-1 infusion. Boluses of 250 mL of colloids were administered if required to maintain the mean arterial pressure above 65 mmHg. RESULTS: Intraoperative crystalloids infused volume were significantly lower in the PVI group (925+/-262 mL vs 1129+/- 160 mL; P=0.04). In contrast, the infused amounts of colloids was higher in the PVI group (725+/-521 mL vs 250+/-224 mL; P=0.01). Interestingly, total fluid amount infused intra- ant postoperatively were similar between the groups (1650+/- 807 mL vs 1379+/-186 mL; P=0.21). CONCLUSION: PVI-guided fluid management in Fast-Track colonic surgery is not necessarily associated with different total volume infused.
The concept of titration can be transposed to fluid management. but does is change the volumes? randomised trial on pleth variability index during fast-track colonic surgery.
Publication date :
2013
Journal title :
Current Clinical Pharmacology
ISSN :
1574-8847
eISSN :
2212-3938
Publisher :
Bentham Science Publishers, Sharjah, United Arab Emirates
Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinicalimplications of perioperative fluid excess. Br J Anaesth 2002;89(4): 622-32.
Holte K, Kehlet H. Fluid therapy and surgical outcomes in electivesurgery: a need for reassessment in fast-track surgery. J Am CollSurg 2006; 202(6): 971-89.
Holte K, Foss NB, Andersen J, et al. Liberal or restrictive fluidadministration in fact-track colonic surgery: a randomized, doubleblindstudy. Br J Anaesth 2007; 99(4): 500-8.
Poeze M, Greve JWM, Ramsay G. Meta-analysis of hemodynamicoptimisation: relationship to methodological quality. Crit Care2005; 9: R771-9.
Cavallaro F, Sandroni C, Antonelli M. Functional hemodynamicmonitoring and dynamic indices of fluid responsiveness. MinervaAnestesiol 2008; 74: 123-35.
Michard F, Teboul JL. Predicting fluid responsiveness in ICUpatients. A critical analysis of the evidence. Chest 2002; 121(6):2000-8.
Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F. Goal-directed fluid management based on pulsepressure variation monitoring during high-risk surgery: a pilotrandomized controlled trial. Crit Care 2007; 11(5): R100.
Desebbe O, Cannesson M. Using ventilation-induced plethysmographicvariations to optimize patient fluid status. Curr OpinAnaesthesiol 2008; 21: 772-8.
Natalini M, Rosano A, Taranto M, Faggian B, Vittorielli E, Bernardini A. Arterial versus plethysmographic dynamic indices totest responsiveness for testing fluid administration in hypotensivepatients: a clinical trial. Anesth Analg 2006; 103(6): 1478-84.
Cannesson M, Desebbe O, Rosamel P, et al. Pleth variabilityindex to monitor the respiratory variations in the pulseoximeter plethysmographic waveform amplitude and predict fluidresponsiveness in the operating theatre. Br J Anaesth 2008; 101(2):200-6.
Cannesson M, Attof Y, Rosamel P, et al. Respiratory variations inpulse oximetry plethysmographic waveform amplitude to predictfluid responsiveness in the operating room. Anesthesiology 2007;106(6): 1105-11.
Forget P, Lois F, De Kock M. Goal-Directed Fluid ManagementBased on the Pulse-Oximeter-Derived Pleth Variability IndexReduces Lactate Levels and Improves Fluid Management. AnesthAnalg 2010; 111(4): 910-4.
Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H. Monitoringof peri-operative fluid administration by individualized goaldirectedtherapy. Acta Anaesthesiol Scand 2007; 51(3): 331-40.
Bundgaard-Nielsen M, Ruhnau B, Secher NH, Kehlet H. Flowrelatedtechniques for preoperative goal-directed fluid optimisation. Br J Anaesth 2007; 98(1): 38-44.
Landsverk SA, Hoiseth LO, Kvandal P, Hisdal J, Skare O, Kirkeboen KA. Poor agreement between respiratory variations inpulse oximetry photoplethysmographic waveform amplitude andpulse pressure in intensive care unit. Anesthesiology 2008; 109(5):849-55.