title: Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery.
abstract: OBJECTIVE
  To evaluate the influence of stroke volume variation (SVV)-based goal-directed therapy (GDT) on splanchnic organ functions and postoperative complications in orthopedic patients.
  
  
  METHODS
  Eighty patients scheduled for major orthopedic surgery under general anesthesia were randomly allocated to one of two equal groups to receive either intraoperative volume therapy guided by SVV (GDT) or standard fluid management (control). In the SVV group, patients received colloid boluses of 4 ml/kg to maintain an SVV <10% when in the supine position or an SVV <14% if prone. In the control group, fluids were given to maintain a mean arterial pressure >65 mm Hg, a heart rate <100 bpm, a central venous pressure of 8-14 mm Hg, and a urine output >0.5 ml/kg/h. Intraoperative organ perfusion, hemodynamic data, hospitalization, postoperative complications, and mortality were recorded.
  
  
  RESULTS
  The heart rate at the end of surgery was significantly lower (p < 0.05), there were fewer hypotensive episodes (p < 0.05), the arterial and gastric intramucosal pH were higher (p < 0.05 for both), the gastric intramucosal PCO2 was lower (p < 0.05), the intraoperative infused colloids and the total infused volume were lower (p < 0.05 for both), and the postoperative time to flatus was shorter (p < 0.05) in the GDT group than in the control group. No differences in the length of hospital stay, complications, or mortality were found between the groups.
  
  
  CONCLUSIONS
  SVV-based GDT during major orthopedic surgery reduced the volume of the required intraoperative infused fluids, maintained intraoperative hemodynamic stability, and improved the perioperative gastrointestinal function.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Peng
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Hao
authors.initials: H
authors.lastname: Cheng
authors.forename: Fu-hai
authors.initials: FH
authors.lastname: Ji
mesh_terms: D001794:Blood Pressure; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005745:Gastric Acidity Determination; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000517:prevention & control*; D005769:Gastrointestinal Motility; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume / Q000502:physiology*; D014556:Urine