title: Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial.
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.
authors.affiliation: Department of Anesthesiology, University of California at Irvine Medical Center, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA. dramsing@uci.edu
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Ramsingh
authors.forename: Chirag
authors.initials: C
authors.lastname: Sanghvi
authors.forename: Joseph
authors.initials: J
authors.lastname: Gamboa
authors.forename: Maxime
authors.initials: M
authors.lastname: Cannesson
authors.forename: Richard L
authors.initials: RL
authors.lastname: Applegate
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D041981:Gastrointestinal Tract / Q000503:physiopathology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D013318:Stroke Volume