Goal Directed Fluid Management , Pvi
Condition: Fluid Overload
Study type: Interventional

Summary: 
      The first objective of this study is to compare the liberal fluid management (LFM) with PVI
      guided goal-directed fluid management (GDFM) in gynecologic oncologic cases in terms of
      controlled intraoperative fluid balance, blood lactate levels, hemodynamic parameters, and
      postoperative serum creatinine levels. 112 patients who are in ASA I-II-lll risk groups
      included in this prospective study.
    

Detailed description: 
      Objectives: The first objective of the investigators's study was to compare the liberal fluid
      management (LFM) with PVI guided goal-directed fluid management (GDFM) in terms of controlled
      intraoperative fluid volume, surgical end-point fluid balance, blood lactate and serum
      creatinine levels.

      The investigators's secondary purpose was to compare the effects of different fluid regimens
      on the postoperative kidney injury and the duration of hospital stay.

      Methods: The study included 112 American Society of Anesthesiologists (ASA) grade I ,ll and
      lll patients, aged above 18 and undergoing elective gynecologic oncologic case . After
      premedication with 0.03 mg /kg i.v. midazolam, all patients were started an i.v. infusion of
      500 mL 0.9 % NaCl until the end of anesthesia induction.

      After the anesthesia induction, while 0.9 % NaCl at rate of 2 mL/kg/h was infused in PVI-
      guided GDFM group, a 250-mL bolus cyristalloid/kolloid injection was administered when PVI
      was higher than 13 % over 5 min. While 0.9 % NaCl at rate of 4- 8 mL/kg/h was infused in LFM
      group, a 250-ml bolus cyristalloid/ kolloid injection was administered when the mean arterial
      blood pressure (MAP) decreased below 65 mmHg. In both groups, when MAP was still < 65 mmHg
      after fluid bolus infusion, 5 mg i.v. bolus ephedrine was administered. The data collected
      during intraoperative period, such as heart rate, MAP, arterial blood gas samples (Ph,
      arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), HCO3 level,
      hemoglobin, blood lactate level) were recorded. Hemoglobin, Na, K, Cl, serum creatinine,
      blood lactate and serum albumin scores were measured preoperatively, and up to 24 hours
      postoperative.

      In the first 24 hours after surgery, urine output, need for blood transfusion
      ,lokositoz,fever,stay in icu and length of hospital stay were recorded.
    

Intervention name(s): pvi guided fluid management
Intervention type(s): Other
Intervention description(s): GDFM Group: 500 ml bolus crystalloid after
2 ml \ kg crystalloid infusion to be started
If PVI <13 MAP is <65 mmHg, continue infusion of fluid, 1-2 µg NE bolus to be entered after 5 min.
PVI <13 MAP> 65 mmHg to continue fluid infusion If PVI> 13 MAP <65 mmHg, 250 ml bolus crystalloid \ colloid will be given and bolus 1-2 µg NE, If it continues after 5 minutes, liquid and NE doses will be repeated. Liquid treatment will be continued until PVI <13.
PVI> 13 MAP <65 mmHg 250 ml bolus fluid to be given, if continued 5 minutes later to be repeated,repetition of fluid will continue until PVl <13.
Other intervention name(s): liberal guided
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other