Restrictive vs Goal Directed Fluid Therapy During Hepatobiliary Surgery
Condition: Liver Surgery
Study type: Interventional

Summary: 
      "Restrictive" fluid management is usually the current standard practice for patients
      undergoing liver surgery. The general idea is to maintain a low central venous pressure in
      order to decrease blood loss and improve the quality of the surgical field. However, this
      strategy , considered as rather "restrictive", can be associated with patient's harm, mainly
      acute kidney injury.

      Today, Goal directed fluid therapy (GDFT) is a well accepted strategy to optimize fluid
      administration in patients undergoing major surgery which aimed to maintain normovolemia
      without being too liberal.

      The goal of this randomized controlled trial is to compare these two strategies on Urethral
      Perfusion index measured with a new IKORUS UP probe (Foley catheter made smarter with
      embedded photoplethysmographic sensing technology).
    

Detailed description: 
      Restrictive fluid administration aiming at maintaining a low central venous pressure
      (low-CVP) during liver surgery has always been considered as a "gold standard" strategy
      because it decrease blood loss and improve the quality of the surgical field. However, this
      strategy , rather "restrictive", can be associated with patient harm (mainly AKI).

      Today, Goal directed fluid therapy (GDFT) is a well accepted strategy to optimize fluid
      administration in patients undergoing major surgery.Some studies have shown that this
      strategy is feasible for such patient population.

      There is currently a lack of data supporting the advantage of one strategy over the other in
      this patient population.While a restrictive fluid strategy can advantage the surgeon, it can
      also disadvantage the patient as in order to avoid hypotension, vasopressors administration
      is required. If the patient is hypovolemic, such strategy may cause acute kidney injury.

      The goal of this randomized controlled trial is to compare these two strategies on Urethral
      Perfusion index measured with a new Foley catheter with embedded photoplethysmographic
      sensing technology). This new technology allows for continuous and easy monitoring of
      urethral tissue perfusion

      The investigators hypothesis is that patients in the GDFT group will have better Urethral
      Perfusion index (uPI) during surgery (via a better cardiac blood flow optimization) compared
      to patients in the restrictive (low CVP) group.
    

Intervention name(s): GDFT; LOW CVP (restrictive group)
Intervention type(s): Procedure; Procedure
Intervention description(s): The titration of fluid will be based on stroke volume variation. The goal is to maintain this variable < 13% during surgery with multiple mini fluid challenge of 100 ml of balanced crystalloid.; Goal = CVP < 7mmHg and only 2 ml/kg/h max during surgery.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Single center randomized controlled superiority study
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment