Targeting individual hemodynamics to maintain renal perfusion during pneumoperitoneum in a porcine model.
BACKGROUND
Although aggressive fluid hydration prevents a decrease in renal cortical perfusion (RCP) during laparoscopic donor nephrectomy, excess fluid is deleterious. We assessed whether goal-directed fluid administration, based on hemodynamic measures, would maintain RCP during pneumoperitoneum with less fluid loading.


METHODS
In a pilot study of 7 pigs, goal-directed fluid administration was guided by monitoring of stroke volume (SV) by esophageal Doppler measurement. During 15 mmHg CO(2) pneumoperitoneum, a bolus of 5 mL/kg 0.9% NaCl was given when SV decreased to 90% of baseline. Next, 18 pigs were randomized into 3 groups: low fluid (5 mL/kg per hour), high fluid (25 mL/kg per hour) and goal directed. Urine output, heart rate, mean arterial pressure, cardiac output, SV, and RCP were recorded every 15 minutes.


RESULTS
Pilot data revealed mean RCP (mL/min per 100 g) was maintained (40 vs 39) during pneumoperitoneum using goal-directed therapy. In the randomized study, RCP was decreased in the low fluid group (43 vs 29; P= .02), but maintained in the high (46 vs 40) and goal-directed (42 vs 39) groups. Mean fluid administered in the goal-directed group during pneumoperitoneum was 10 mL/kg and only 3 of 6 of pigs required boluses. Urine output was decreased in all 3 groups.


CONCLUSIONS
A goal-directed strategy during pneumoperitoneum allows for tailored fluid administration and maintains RCP with lower volumes of intravenous fluid.
Demyttenaere
Sebastian V
SV
Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Quebec, Canada.
Taqi
Ali
A
Polyhronopoulos
Gerry N
GN
Bergman
Simon
S
Stanbridge
Donna D
DD
Unikowsky
Bernard
B
Carli
Franco
F
Fried
Gerald M
GM
Feldman
Liane S
LS
D000818:Animals; D001013:Aorta, Thoracic / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate / Q000502:physiology*; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry / Q000295:instrumentation / Q000379:methods; D010477:Perfusion / Q000379:methods; D010865:Pilot Projects; D011027:Pneumoperitoneum / Q000503:physiopathology / Q000628:therapy*; D011897:Random Allocation; D012039:Regional Blood Flow / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology*; D013552:Swine