Influence of postoperative fluid management on pulmonary function after esophagectomy.
OBJECTIVE
The aim of this study was to investigate the effects of a restrictive vs. a liberal postoperative fluid therapy guided by intrathoracic blood volume index (ITBVI) on hemodynamic and pulmonary function in patients undergoing elective esophagectomy. Perioperative fluid therapy may influence postoperative physiology and morbidity after esophageal surgery. Definitions of adequate infusion amounts and evident rules for a fluid therapy are missing.


METHODS
After esophagectomy, 22 patients were randomized either to a restrictive group (RG) with low range of ITBVI (600-800 ml/m2) or a liberal group (LG) with normal ITBVI (800-1000 ml/m2). Infusion regimen was modified twice a day according to transpulmonary thermodilution measurements until the 5th postoperative day. Primary endpoint was paO2/FIO2-ratio. Secondary endpoints were pulmonary function, fluid balance and hemodynamic as well as morbidity.


RESULTS
Demographic and surgical details did not differ between both groups. The calculated sample size was not reached. There were no postoperative differences in paO2/FIO2-ratio, ITBVI, hemodynamic parameters, or morbidity either. Cumulative fluid uptake was 4.1 liter less in the RG on the 5th postoperative day (p = 0.01), and pulmonary function was better in these patients (area under curve day 2-7 for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) each <0.05).


CONCLUSIONS
ITBVI guided restrictive infusion therapy yields a lower fluid uptake, but may not result in a difference of clinical relevant parameters. A fluid restriction after esophagectomy should always be combined with hemodynamic monitoring because additional infusions may be required.
Department of General, Visceral, Vascular, and Thoracic Surgery, Charite-University Medicine Berlin, Campus Mitte, Germany. oliver.haase@charite.de
O
O
Haase
Department of General, Visceral, Vascular, and Thoracic Surgery, Charite-University Medicine Berlin, Campus Mitte, Germany.
W
W
Raue
Department of General, Visceral, Vascular, and Thoracic Surgery, Charite-University Medicine Berlin, Campus Mitte, Germany.
H
H
Neuss
Department of General, Visceral, Vascular, and Thoracic Surgery, Charite-University Medicine Berlin, Campus Mitte, Germany.
G
G
Koplin
Department of General, Visceral, Vascular, and Thoracic Surgery, Charite-University Medicine Berlin, Campus Mitte, Germany.
U
U
Mielitz
Department of General and Visceral Surgery, Asklepios Klinik Altona, Hamburg, Germany.
W
W
Schwenk
D000368:Aged; D001810:Blood Volume; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011184:Postoperative Period; D012129:Respiratory Function Tests