Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive
OBJECTIVE: The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier España
2012-10-01
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| Series: | Clinics |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322012001000006 |
| _version_ | 1811317149538451456 |
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| author | Jun Zhang Hui Qiao Zhiyong He Yun Wang Xuehua Che Weimin Liang |
| author_facet | Jun Zhang Hui Qiao Zhiyong He Yun Wang Xuehua Che Weimin Liang |
| author_sort | Jun Zhang |
| collection | DOAJ |
| description | OBJECTIVE: The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution. METHOD: A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints. RESULTS: The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups. CONCLUSION: Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II. |
| first_indexed | 2024-04-13T12:02:57Z |
| format | Article |
| id | doaj.art-ad51e65243704c709dedc78580383ece |
| institution | Directory Open Access Journal |
| issn | 1807-5932 1980-5322 |
| language | English |
| last_indexed | 2024-04-13T12:02:57Z |
| publishDate | 2012-10-01 |
| publisher | Elsevier España |
| record_format | Article |
| series | Clinics |
| spelling | doaj.art-ad51e65243704c709dedc78580383ece2022-12-22T02:47:44ZengElsevier EspañaClinics1807-59321980-53222012-10-0167101149115510.6061/clinics/2012(10)06Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictiveJun ZhangHui QiaoZhiyong HeYun WangXuehua CheWeimin LiangOBJECTIVE: The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer's solution and 6% hydroxyethyl starch solution. METHOD: A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer's group (n = 20), a goal-directed lactated Ringer's group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer's solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints. RESULTS: The goal-directed lactated Ringer's group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer's group and the restrictive lactated Ringer's group. No significant differences were found in the postoperative complications among the three groups. CONCLUSION: Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322012001000006Pulse Pressure VariationGoal-Directed Fluid TherapyRestrictive Fluid TherapyGastrointestinal Surgery |
| spellingShingle | Jun Zhang Hui Qiao Zhiyong He Yun Wang Xuehua Che Weimin Liang Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive Clinics Pulse Pressure Variation Goal-Directed Fluid Therapy Restrictive Fluid Therapy Gastrointestinal Surgery |
| title | Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive |
| title_full | Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive |
| title_fullStr | Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive |
| title_full_unstemmed | Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive |
| title_short | Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive |
| title_sort | intraoperative fluid management in open gastrointestinal surgery goal directed versus restrictive |
| topic | Pulse Pressure Variation Goal-Directed Fluid Therapy Restrictive Fluid Therapy Gastrointestinal Surgery |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322012001000006 |
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