Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients

Demirel, İsmail; Bolat, Esef; Altun, Aysun Yıldız; Özdemir, Mustafa; Beştaş, Azize

doi:10.1007/s11695-017-2840-1

Cited by 36 publications

(27 citation statements)

References 34 publications

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“…Several studies have shown that PVI guided GDFT, when compared to fluid therapy guided by static parameters of fluid responsiveness, can lead to decreased infused fluid volume, decreased time to first stool, and decreased perioperative lactate levels [12, 13, 23, 24]. Trials comparing different GDFT strategies to PVI, such as esophageal Doppler, have however resulted in conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

et al. 2019

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Background Goal-directed fluid therapy (GDFT) based on dynamic indicators of fluid responsiveness has been shown to decrease postoperative complications and hospital length of stay (LOS) in patients undergoing major abdominal surgery. The usefulness of this approach still needs to be clarified in low-to-moderate risk abdominal surgery. Both pulse-pressure variation (PPV) and pleth variability index (PVI) can be used to guide GDFT strategies. The objective of this prospective randomized controlled trial was to determine if the use of PVI guided GDFT, when compared to PPV guided GDFT, would lead to similar hospital LOS in patients undergoing low-to-moderate risk surgery. Secondary outcomes included amount of fluid administered and incidence of postoperative complications. Methods Patients were randomized into either PVI or PPV guided GDFT groups. Both received a baseline 2 ml kg − 1 h − 1 Lactated Ringer infusion. Additional fluid boluses consisted of 250 mL of colloid that was infused over a 10 min period if PVI was > 15% or PPV was > 13% for at least five minutes. The primary outcome was to determine if hospital LOS, which was defined as the number of days from surgery up to the day the surgeon authorized hospital discharge, was equivalent between the two groups. Results A total of 76 patients were included and they were randomized into two groups of 38 patients. Baseline characteristics were similar in both groups. Both PVI and PPV guided GDFT strategies were equivalent for the primary outcome of LOS (median [interquartile range]) (days) 2.5 [2.0–3.3] vs. 3.0 [2.0–5.0], p = 0.230, respectively. Fluids infused, postoperative complications, and all other outcomes were not different between groups. Conclusion In patients undergoing low-to-moderate risk abdominal surgery, PVI seems to guide GDFT similarly to PPV in regards to hospital LOS, amount of fluid, and incidence of postoperative complications. However, in low-risk patients undergoing these surgical procedures optimizing stroke volume may have limited impact on outcome. Trial registration ClinicalTrials.gov Identifier: NCT02908256 , September 2016, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12871-019-0707-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

et al. 2019

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“…Postoperative bleeding is a rare but serious complication, occurring in < 1% of patients, and can be prevented with a standard intraoperative protocol that increases blood pressure and reduces the pneumoperitoneum to identify possible silent bleeding sites . Goal‐directed fluid therapy is also recommended during bariatric surgery, and the potential for excessive IV fluid administration can be mitigated using dynamic indicators, such as the Pleth Variability Index (PVI) .…”

Section: Executive Summarymentioning

confidence: 99%

“…Intraoperative and postoperative fluid management in patients undergoing bariatric surgery should be goal directed . Utilizing continuous noninvasive measurements of fluid status, such as the PVI, stroke volume variation, or other technologies, results in less fluid administration during bariatric surgery than empiric calculations of volume requirements or by monitoring urine output . Administration of excess IV fluids can increase the rate of postoperative nausea and length of stay after surgery .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

340

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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“…Proper fluid balance is therefore suggested. Goal‐directed fluid therapy may be useful to optimize intraoperative fluid management. Compared with a conservative/restrictive approach, liberal intraoperative fluid management during bariatric surgery does not reduce the incidence of rhabdomyolysis nor increase intraoperative urine output.…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

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Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients

Cited by 36 publications

References 34 publications

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial

Perioperative care of the obese patient

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