Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position

Bacchin, Maria Renata; Ceria, Chiara Marta; Giannone, Sandra; Ghisi, Daniela; Stagni, G.; Greggi, Tiziana; Bonarelli, S.

doi:10.1097/brs.0000000000001601

Cited by 62 publications

(45 citation statements)

References 22 publications

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“…The applied protocol for GDT significantly reduced amount of intraoperative crystalloid infusion and despite of the significantly higher amount of received colloid, the total amount of FT was significantly less than with CT. On contrary, Lin et al [16] and Srinivasa et al [29,30] reported no significant difference in the overall fluid volumes administered intraoperatively between patients with and without GDT, but patients in GDT group received significantly higher volume of colloid fluids. However, in hand with the current study, multiple recent studies reported similar significant reduction of administered fluid with GDT [17,[19][20][21].…”

Section: Parametersupporting

confidence: 70%

“…PO blood lactate levels were significantly higher in patients of both groups compared to their preoperative levels, but were significantly lower in patients of GDT than those of CT group; these findings spotlight on proper tissue perfusion and oxygenation with maintenance of metabolism towards aerobic arm, facilitating lactate consumption through Cori cycle for glucose synthesis and metabolism. In line with these findings; Bacchin et al [20], Benes et al [26] and Yu et al [27] found lactate levels at the end of surgery were lower with GDT compared to CT.…”

Section: Parametermentioning

confidence: 62%

“…On the other hand, Manecke et al [18] found GDT decreased morbidity rate with subsequent gross costs saving and Muñoz et al [19] found implementation of GDT significantly reduced PO nausea and vomiting after laparoscopic sleeve gastrectomy in morbidly obese patients. Also, Bacchin et al [20] reported that patients received GDT had fewer pulmonary complications and faster return of bowel function after major spine surgery. Furthermore, Kratz et al [21] reported significantly fewer severe Table 3 Intraoperative hemodynamic and UOP data of patients of both groups.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Elgendy

Esmat

Kassim

2017

Egyptian Journal of Anaesthesia

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The Vigileo-FloTrac system High-risk patients Major abdominal surgeries Postoperative Morbidity Mortality a b s t r a c tBackground: This study evaluated impact of intraoperative goal-directed therapy (GDT) judged by changes of stroke volume variation (SVV) and cardiac index (CI) using the Vigileo/FloTrac system on postoperative (PO) morbidities and mortality rates in high risk patients scheduled for major abdominal surgeries in comparison to conventional fluid therapy (CT). Methods: 86 patients were randomly allocated into one of two equal groups: CT group = 43 patients received crystalloid solution and on demand bolus of 250 ml colloids with possible addition of vasopressor or inotrope to target MAP at 60-90 mmHg, CVP at 8-12 mmHg and urine output at >0.5 ml/kg/hr and GDT group = 43 patients received crystalloid fluid therapy (FT) and colloids (3 ml/kg) with possible addition of vasopressor or inotrope according to predefined protocol with a target CI 2.5 L/min/m 2 , SVV < 12% with MAP > 65 mmHg. Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) was used to predict morbidity and mortality rates. Study outcomes included ICU and total hospital morbidity and mortality rates and length of stay (LOS). Results: Intraoperative GDT reduced ICU morbidity rate (16.3%) than the POSSUM predicted rate (39.78%) and significantly (p = 0.039) than CT group (37.2%), while in CT group ICU morbidity rate coincided with POSSUM predicted rate (42.86%). ICU and total hospital LOS were significantly shorter with GDT group than with CT group. However, mortality rates weren't significantly lower with GDT group than CT group (7% vs. 11.6%). The applied protocol for intraoperative GDT reduced significantly crystalloid infusion and despite of significantly higher amount of received colloids, the total amount of FT was significantly less than CT group. Conclusion: The applied protocol for intraoperative GDT provided significant reduction of PO morbidities, ICU and hospital LOS but couldn't significantly reduce mortality rates in high risk patients scheduled for major abdominal surgeries.

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Section: Parametersupporting

confidence: 70%

Section: Parametermentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Elgendy

Esmat

Kassim

2017

Egyptian Journal of Anaesthesia

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“…12,14 Fluid management was performed under goal direction by using pulse pressure variability, stroke volume variability, or cardiac output. 2 Tranexamic acid (1 g) was given as a bolus prior to incision, and 1 g was given over 8 hours when massive blood loss was expected and under the direction of the attending surgeon.…”

Section: Enhanced Perioperative Carementioning

confidence: 99%

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Carr

Saigal

Zhang

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to compare total cost and length of stay (LOS) between spine surgery patients enrolled in an enhanced perioperative care (EPOC) pathway and patients receiving traditional perioperative care (TRDC).METHODSAll spine surgery candidates were screened for inclusion in the EPOC pathway. This cohort was compared to a retrospective cohort of patients who received TRDC and a concurrent group of patients who met inclusion criteria but did not receive the EPOC (no pathway care [NOPC] group). Direct and indirect costs as well as hospital and intensive care LOSs were analyzed between the 3 groups.RESULTSTotal costs after pathway implementation decreased by $19,344 in EPOC patients compared to a historical cohort of patients who received TRDC and $5889 in a concurrent cohort of patients who did not receive EPOC (NOPC group). Hospital and intensive care LOS were significantly lower in EPOC patients compared to TRDC and NOPC patients.CONCLUSIONSThe implementation of a multimodal EPOC pathway decreased LOS and cost in major elective spine surgeries.

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“…Published literature describing the use of GDFT in spine surgeries is limited ( 6 , 13 , 53 , 54 ). Dynamic indices such as pulse pressure variation, stroke volume variation, corrected flow time, and plethysmography index variability have been commonly used to predict fluid responsiveness among GDFT trials ( Table 1 ) ( 33 , 34 , 55 , 56 ).…”

Section: Physiologic Changes During Prone Positioningmentioning

confidence: 99%

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

et al. 2020

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Fluid management has been widely recognized as an important component of the perioperative care in patients undergoing major procedures including spine surgeries. Patient-and surgery-related factors such as age, length of the surgery, massive intraoperative blood loss, and prone positioning, may impact the intraoperative administration of fluids. In addition, the type of fluid administered may also affect post-operative outcomes. Published literature describing intraoperative fluid management in patients undergoing major spine surgeries is limited and remains controversial. Therefore, we reviewed current literature on intraoperative fluid management and its association with post-operative complications in spine surgery.

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Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position

Abstract: 3.

Cited by 62 publications

References 22 publications

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

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