Effects of volumetric vs. pressure-guided fluid therapy on postoperative inflammatory response: a prospective, randomized clinical trial.
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.
Szakmany
Tamas
T
Department of Anesthesiology and Intensive Care, University of Pécs, Pécs, Hungary. szakmany@hotmail.com
Toth
Ildiko
I
Kovacs
Zsolt
Z
Leiner
Tamas
T
Mikor
Andras
A
Koszegi
Tamas
T
Molnar
Zsolt
Z
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
C000606589:CALCA protein, human; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide