title: Effects of volumetric vs. pressure-guided fluid therapy on postoperative inflammatory response: a prospective, randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Forty patients undergoing major abdominal surgery were randomized into CVP and ITBV groups.
  
  
  METHODS
  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.
  
  
  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-alpha 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-alpha 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.
  
  
  CONCLUSIONS
  ITBV guided fluid therapy did not alter the magnitude of inflammatory response as monitored by serum PCT, CRP, and TNF-alpha in the early postoperative period.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Pécs, Pécs, Hungary. szakmany@hotmail.com
authors.forename: Tamas
authors.initials: T
authors.lastname: Szakmany
authors.forename: Ildiko
authors.initials: I
authors.lastname: Toth
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Kovacs
authors.forename: Tamas
authors.initials: T
authors.lastname: Leiner
authors.forename: Andras
authors.initials: A
authors.lastname: Mikor
authors.forename: Tamas
authors.initials: T
authors.lastname: Koszegi
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Molnar
mesh_terms: D001811:Blood Volume Determination; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D015740:Calcitonin Gene-Related Peptide; D002496:Central Venous Pressure; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*; D013815:Thermodilution; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide