Comparison of PVI-guided Fluid Management With Traditional Fluid Management in Colorectal Surgery
Condition: Fluid Overload
Study type: Interventional

Summary: 
      The first objective of this study was to compare the traditional fluid management (TFM) 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. ASA I-II
      70 patients included in this prospective study.
    

Detailed description: 
      Objectives: The first objective of our study was to compare the traditional fluid management
      (TFM) 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. Our secondary purpose was to compare the effects of different fluid
      regimens on the return of bowel function and the duration of hospital stay. Methods: The
      study included 70 American Society of Anesthesiologists (ASA) grade I and II patients, aged
      above 18 and undergoing elective colorectal surgery. 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 gelatin injection (Gelofusine®, Barun) 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 TFM group, a 250-ml bolus gelatin injection (Gelofusine®, Barun) 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, oliguria (<0.5 ml / kg urine output), need for blood
      transfusion and the time of first bowel movement (depending on the days after surgery),
      length of hospital stay were recorded.
    

Intervention name(s): pvı-guided; traditional-guided
Intervention type(s): Other; Other
Intervention description(s): pvı- guided total amount of crystalloid volume of fluid infused during colorectal surgery pvı-guided(according to pvi value) fluid infused during whole procedure 2 ml/kg/h infusion during surgery If PVI value <%13 and if MAP>65mmHg continue with 2 ml/kg/h cristalloid infusion If PVI value <%13 and if MAP>65mmHg 5 mcg efedrin intravenous bolus till MAP>65 mmHg If PVI value >%13 and MAP>65 mmHg infuse 250 ml Gelofusine bolus up to PVI value lowers to %13 every 5 minute If PVI value >%13 and MAP <65 mmHg infuse 250 ml Gelofusine bolus and 5 mcg efedrin intravenous up to PVI value lowers to %13; traditional-guided total amount of crystalloid volume of fluid infused during colorectal surgery traditional-guided fluid infused during whole procedure 4-8 ml/kg/h infusion during surgery If MAP <65 mmHg or <30%of basal value, infuse 250 ml Gelofusine bolus and 5 mcg efedrin If MAP>65 mmHg no intervention
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Diagnostic
Keywords: COLORECTAL SURGERY; PVI GUIDED FLUID MANAGEMENT; GOAL DIRECTED THERAPY