title: Does goal-directed fluid therapy affect postoperative orthostatic intolerance?: A randomized trial.
abstract: BACKGROUND
  Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume-guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial.
  
  
  METHODS
  Forty-two patients scheduled for open radical prostatectomy were randomized into standard fluid therapy (control group) or GDT groups. Both groups received a fixed-volume crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid, and in addition, the GDT group received colloid to obtain a maximal stroke volume (esophageal Doppler). The primary outcome was the prevalence of OI assessed with a standardized mobilization protocol before and 6 h after surgery. Hemodynamic and hormonal orthostatic responses were evaluated.
  
  
  RESULTS
  Twelve (57%) versus 15 (71%) patients in the control and GDT groups (P = 0.33), respectively, demonstrated OI after surgery, group difference 14% (CI, -18 to 45%). Patients in the GDT group received more colloid during surgery (1,758 vs. 1,057 ml; P = 0.001) and reached a higher stroke volume (102 vs. 89 ml; P = 0.04). OI patients had an increased length of hospital stay (3 vs. 2 days; P = 0.02) and impaired hemodynamic and norepinephrine responses on mobilization.
  
  
  CONCLUSIONS
  GDT did not reduce the prevalence of OI, and patients with OI demonstrated impaired cardiovascular and hormonal responses to mobilization.
authors.affiliation: * Research Fellow, ‡ Research Assistant, Section of Surgical Pathophysiology, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, and Department of Anesthesiology, The Abdominal Center, Copenhagen University Hospital, Rigshospitalet. † Research Fellow, †† Professor, Section of Surgical Pathophysiology, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet. § Staff Anesthesiologist, ‖ Head of Department, ** Professor, Department of Anesthesiology, The Abdominal Center, Copenhagen University Hospital, Rigshospitalet. # Professor, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Bundgaard-Nielsen
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Jans
authors.forename: Rasmus G
authors.initials: RG
authors.lastname: Müller
authors.forename: André
authors.initials: A
authors.lastname: Korshin
authors.forename: Birgitte
authors.initials: B
authors.lastname: Ruhnau
authors.forename: Peter
authors.initials: P
authors.lastname: Bie
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000368:Aged; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D003718:Denmark; D004311:Double-Blind Method; D004434:Early Ambulation / Q000379:methods; D005440:Fluid Therapy / Q000379:methods*; D006040:Goals; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D054971:Orthostatic Intolerance / Q000628:therapy*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions