Goal Directed Fluid Therapy Guided Fluid Management in Pneumoresection

Study Overview
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Brief Summary
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Perioperative fluid management is a key component of anesthetic management during thoracic surgery. On one hand, fluid restriction could compromise perfusion of vital organs and surgical anastomosis. On the other hand, fluid overload could lead to cardiopulmonary complications, notably pulmonary edema, which carries a high mortality rate. Perioperative fluid management to avoid postpneumonectomy pulmonary edema has been previously reviewed. Therefore, to achieve the balance between preventing fluid overload and optimising organ perfusion, the practical index to guide fluid management, which can predict whether fluid loading will improve haemodynamic conditions in an individual patient, would be very valuable during lung surgery. Perioperative goal-directed fluid therapy (GDFT) is a cornerstone of tissue perfusion and oxygenation, and it can improve surgical outcomes. Respiratory variations of arterial pressure [i.e. pulse pressure variation (PPV) and systolic pressure variation] can predict fluid responsiveness in mechanically ventilated patients under various conditions. Therefore, pressure variations are increasingly being advocated for fluid management.This study will discuss the effects of pulse pressure variation(PPV) in different level during anesthesia on patients with oxygenation index and short-term prognosis undergoing video-assisted thoracoscopic surgery for pneumoresection.

Official Title
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Goal Directed Fluid Therapy Guided Fluid Management in Pneumoresection: a Randomized Controlled Trial

Conditions
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Goal-directed Fluid Therapy

Intervention / Treatment
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* Device: Fluid therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists physical status I-III; aged 18-60 years old; BMI 18.5   28 kg/m2 Exclusion Criteria: Refused to participate in the experiment, hepatic/renal/cardiac dysfunction, severe valvular disease, frequent arrhythmia, moderate anemia and severe electrolyte disturbance before operation.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional therapy group<br>Patients in Conventional therapy group were received fluid therapy: intraoperative transfusion volume=maintenance fluids+deficit replacement+restoration of losses and with heart rate, mean arterial pressure, urine measurement ect. | Device: Fluid therapy<br>* Conventional therapy group: conventional arterial blood pressure monitoring. Low value of PPV group and high value of PPV group:pulse pressure variation monitoring with arterial blood pressure monitoring.<br>|
| Experimental: Low value of PPV group<br>Patients in low value of PPV group were received fluid therapy according to PPV (3% ≤PPV < 5%) . | Device: Fluid therapy<br>* Conventional therapy group: conventional arterial blood pressure monitoring. Low value of PPV group and high value of PPV group:pulse pressure variation monitoring with arterial blood pressure monitoring.<br>|
| Experimental: High value of PPV group<br>Patients in high value of PPV group were received fluid therapy according to PPV (5% ≤PPV < 8%) . | Device: Fluid therapy<br>* Conventional therapy group: conventional arterial blood pressure monitoring. Low value of PPV group and high value of PPV group:pulse pressure variation monitoring with arterial blood pressure monitoring.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Oxygenation Index in 48 hours |  | Before induction, 5 minutes before the end of one-lung ventilation, 48 hours after the operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The duration of surgery |  | During surgery period | 
| The duration of mechanical ventilation |  | During surgery period | 
| Crystalloid administered |  | During surgery period | 
| Colloid administered |  | During surgery period | 
| Blood loss |  | During surgery period | 
| Urine output |  | During surgery period | 
| Number of patients received vasopressor |  | During surgery period | 
| Blood pressure |  | Before the surgery and 48 hours after surgery | 
| Leukocyte |  | Before the surgery and 48 hours after surgery | 
| Hematocrit |  | Before the surgery and 48 hours after surgery | 
| Complication until hospital discharge |  | 1 month after surgery | 
| Hospital stay postoperatively |  | 1 month after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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goal-directed fluid therapy, thoracic surgery, video-assisted, acute lung injury