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

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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.

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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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Acknowledgments

This study was supported by the Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, USA.

Conflict of interest

D.R. received speaking fees from Edwards Lifesciences, Irvine, CA, USA. M.C. is consultant and/or speakers for Edwards Lifesciences, Covidien, Masimo, Fresnius Kabi, ConMed, and Bmeye. R.A. currently principal investigator for ongoing study for which the Department of Anesthesiology, Loma Linda University School of Medicine is sponsored by Edwards Lifesciences, Irvine, CA, USA.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of California at Irvine Medical Center, 333 The City Boulevard West, Suite 2150, Orange, CA, 92868, USA

    Davinder S. Ramsingh & Maxime Cannesson

  2. Pain Management, Cleveland Clinic Foundation, Cleveland, OH, USA

    Chirag Sanghvi

  3. Internal Medicine, Huntington Memorial Hospital, Pasadena, CA, USA

    Joseph Gamboa

  4. Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, USA

    Richard L. Applegate II

Authors
  1. Davinder S. Ramsingh
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  2. Chirag Sanghvi
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  3. Joseph Gamboa
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  4. Maxime Cannesson
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  5. Richard L. Applegate II
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Corresponding author

Correspondence to Davinder S. Ramsingh.

Appendix

Appendix

See Table 5.

Table 5 Quality of recovery score survey
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Ramsingh, D.S., Sanghvi, C., Gamboa, J. et al. Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. J Clin Monit Comput 27, 249–257 (2013). https://doi.org/10.1007/s10877-012-9422-5

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  • DOI: https://doi.org/10.1007/s10877-012-9422-5

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