Does Central Venous Oxygen Saturation-directed Fluid Therapy Affect Postoperative Morbidity after Colorectal Surgery?

Abstract

Clinical outcomes among patients receiving Scvo2-guided perioperative fluid therapy were similar to those for patients treated with a traditional fluid regimen. Limitations in study design prevent full interpretation of these findings, and further large trials of this treatment algorithm are still required.

Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery—a systematic review and meta-analysis of randomized controlled trials

“…Eight trials [26, 29, 30, 46, 50, 53, 54, 56] used pulmonary arterial catheters for monitoring; fourteen trials [3, 11, 14, 32, 33, 36, 42, 44, 48, 49, 51, 55, 62, 64] used esophageal Doppler monitoring; fifteen trials [3, 12, 27, 28, 31, 38, 39, 41, 43, 45, 52, 59–61, 65] used self-calibrating/calibrated pulse contour analysis monitoring; and the remaining eight trials used other monitors, including arterial lines plus monitoring equipment [40], central lines and arterial line sampling [34, 37, 57], pulse oximeters [35, 58], and other noninvasive monitors [13, 47]. Three types of goals were used in the majority of included trials, including DO 2 I and/or cardiac index [13, 26, 29, 30, 43, 46, 50, 53, 54, 56, 59], optimal SV [1, 11, 28, 32, 33, 36, 38, 39, 42, 44, 48, 49, 51, 55], and dynamic measures of preload responsiveness (e.g., PPV, SVV, PVI) [12, 27, 31, 35, 40, 41, 45, 52, 58, 60, 61, 65].…”

What is a fluid challenge?

“…An ScVO 2 of less than 70% is defined as an indicator and target for early resuscitation in sepsis, reducing in-hospital mortality [27]. A recent RCT of intraoperative fluid challenges to achieve an ScVO 2 of 75% did not show a reduction in postoperative complications [28]. Interestingly, the ScVO 2 group received less fluids than the control group.…”

Anesthesia for Colorectal Surgery

“…However, GDT based on pulse contour analysis and aiming to minimize stroke volume variations during the respiratory cycle of mechanically ventilated patients has also been shown to decrease morbidity and accelerate recovery, especially in high-risk patients. 93 100 Intraoperative cardiac output monitoring is also useful to guide fluid therapy during hemodynamic changes induced by pneumoperitoneum and patient positioning, and avoids unnecessary fluid administration. Arterial hypotension induced by general anesthesia or epidural analgesia should be treated with vasopressors when administration of intravenous fluid fails to increase stroke volume by more than 10%, 52,94,101 as low-dose vasopressors do not impair colonic oxygenation.…”