Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial

  • Davinder S. Ramsingh
  • Chirag Sanghvi
  • Joseph Gamboa
  • Maxime Cannesson
  • Richard L. ApplegateII
Original Research

Abstract

Intraoperative goal directed fluid therapy (GDT) guided by an arterial pressure-based cardiac output system has been reported to improve gastrointestinal (GI) recovery in high-risk patients. This study evaluates the impact of this approach on GI recovery in low to moderate risk patients undergoing major abdominal surgery. IRB approved randomized controlled trial in low to moderate risk adults scheduled for major surgery. Patients were randomized to standard (n = 20) or GDT (n = 18) groups, whose fluids were managed to maintain stroke volume variation (SVV) <12 %. The primary outcome measure was GI recovery. Additional measures included quality of recovery score. Continuous, non-normally distributed by Mann–Whitney test; ordinal and nominal by Chi square analysis. GDT patients had lower average intraoperative SVV. The GDT group had faster return of GI function (p = 0.004) and higher quality of recovery scores. In low to moderate risk patients undergoing major abdominal surgery, intraoperative GDT guided by SVV optimization was associated with faster restoration of GI recovery and higher quality of recovery scores. These results suggest that outcome benefits related to the use of an intraoperative goal directed fluid protocol guided by SVV are not limited to high-risk patients.

Keywords

Goal directed therapy Intraoperative hemodynamic monitoring Stroke volume variation Stroke volume optimization 

Abbreviations

GDT

Goal directed fluid therapy

SVV

Stroke volume variation

P-POSSUM

Portsmouth physiologic and operative severity score for the enumeration of mortality and morbidity score

ASA

American Society of Anesthesiologists

LOS

Length of hospital stay

POD

Postoperative day

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Davinder S. Ramsingh
    • 1
  • Chirag Sanghvi
    • 2
  • Joseph Gamboa
    • 3
  • Maxime Cannesson
    • 1
  • Richard L. ApplegateII
    • 4
  1. 1.Department of AnesthesiologyUniversity of California at Irvine Medical CenterOrangeUSA
  2. 2.Pain ManagementCleveland Clinic FoundationClevelandUSA
  3. 3.Internal MedicineHuntington Memorial HospitalPasadenaUSA
  4. 4.Department of AnesthesiologyLoma Linda University School of MedicineLoma LindaUSA

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