Effects of volumetric vs. pressure-guided fluid therapy on postoperative inflammatory response: a prospective, randomized clinical trial
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To compare intrathoracic blood volume (ITBV) guided fluid management and central venous pressure (CVP) guided therapy in ameliorating the progression of early systemic inflammatory response in patients undergoing major surgery.
Prospective, randomized clinical trial.
Forty patients undergoing major abdominal surgery were randomized into CVP and ITBV groups.
In the CVP group the target CVP was 8–12 mmHg while in the ITBV group the goal was to keep the ITBV between 850 and 950 ml/m2 during the operation.
Measurements and results
Hemodynamic parameters were determined by single arterial thermodilution. Measurements were repeated every 30 min intraoperatively. Serum procalcitonin (PCT) and C-reactive protein (CRP) was monitored preoperatively, on ICU admission, and then daily for 3 days. Serum TNF-α levels were measured intraoperatively hourly and then daily for 3 days. There was no significant difference between the two groups regarding hemodynamic parameters at any assessment point. In the overall population changes in the stroke volume index showed a significant correlation with changes in CVP and ITBV. TNF-α levels remained in the normal range intraoperatively and during the three postoperative days in both groups. Preoperatively normal PCT and CRP levels increased significantly postoperatively, without significant differences between the groups.
ITBV guided fluid therapy did not alter the magnitude of inflammatory response as monitored by serum PCT, CRP, and TNF-α in the early postoperative period.
KeywordsSystemic inflammatory response Intrathoracic blood volume index Central venous pressure Procalcitonin Tumor necrosis factor α C-reactive protein
The authors are indebted to Miss Ibolya Orosz for her technical assistance. The study was partially funded by NKFP 1A/0026 research grant, Ministry of Education, Hungary.
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