Pulse-induced Continuous Cardiac Output Monitor versus Trans-esophageal Doppler Monitor for Optimization of Fluid Management in Patients Undergoing Major Abdominal Surgery. A Comparative Study

This work was carried out in collaboration between all authors. Author HFH contributed to the study design, pilot results, calculated sample size, anesthetized and followed up patients, helped in collecting data and revised the medical charts. Author MZA contributed to the study design, pilot results, calculated sample size, supervised anaesthesia and follow-up of patients, helped perform the statistical analysis and drafted the manuscript. Authors AIR and MMA contributed to the study design and revised the manuscript. Author ASEH helped collect data, revise the medical charts, perform the statistical analysis, and draft the manuscript. Author NGES helped collecting data, revised the medical charts, and drafted the manuscript. Author RSE helped collecting data and revised the medical charts. ABSTRACT Background: Perioperative fluid management is essential to the practice of anaesthesia. Outcomes may be improved if fluid therapy is individualized according to the patient's fluid responsiveness. Pulse-induced continuous cardiac output (PiCCO) monitor is an invasive device that quantifies several parameters, including cardiac output (CO), stroke volume variation (SVV) and extravascular lung water (EVLW). Trans-oesophageal Doppler monitoring (TED) is another minimally invasive form and has the benefit of providing beat to beat analysis. Aim of Work: We designed this prospective, randomized comparative study to evaluate the use of PiCCO monitor from the fluid and haemodynamic point of view in comparison to TED monitor in order to maintain an adequate circulatory volume ensuring end-organ perfusion and oxygen delivery. Patients and Methods: This study was performed on 72 patients of either sex (ASA I-II), undergoing major abdominal surgery. Patients were randomly allocated into two groups; PiCCO group ( n =36); where fluid management was guided by SVV & colloid boluses were given to maintain SVV below 10% and TED group ( n =36); where fluid management was guided by (systolic flow time corrected for heart rate) (FT c ) & colloid was infused when the (FT c ) ˂ 0.35 second, the fluid challenge would be repeated until FT c raised ˃ 0.40 second with no change in SV. Laboratory parameters of organ hypoperfusion in perioperative period were recorded as well as the number of postoperative complications, mortality and length of ICU stay. Results: PiCCO group received more intraoperative colloids ( P =0.001) and had lower incidence of hypotensive events ( P =0.001). Postoperative lactate levels were lower in PiCCO group ( P =0.04). PiCCO group showed fewer numbers of patients developed complications & overall number of postoperative complications ( P =0.01). It also showed shorter duration of ICU length of stay ( P =0.01). No mortality was recorded in both groups. Conclusions: During major abdominal surgery; intraoperative fluid optimization using PiCCO monitor showed more haemodynamic stability and was associated with a lower incidence of postoperative complications, organ dysfunction and infectious complications with a tendency to decrease the ICU length of stay in comparison to TED monitor.