title: Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery.
abstract: BACKGROUND
  The impact of different approaches to fluid management during intraoperative volume resuscitation in patients undergoing major elective surgery is poorly defined. We compared volume effectiveness of crystalloid and colloid substitution aimed to maintain the cardiac index (CI) between 2.6 and 3.8 l/min/m(2) as measured by transesophageal Doppler (TED).
  
  
  METHODS
  A total of 115 urological patients were enrolled in the prospective randomized trial and then randomized into 2 groups, one with volume therapy based on crystalloids (n = 57) and the other with colloids (n = 58). A TED probe was inserted and then hemodynamic optimization (therapy with Ringer's solution or hydroxyethyl starch 6 % 130/0.4 and administration of vasoactive drugs) was started according to TED variables to maintain the CI between 2.6 and 3.8 l/min/m(2).
  
  
  RESULTS
  We observed high incidence of CI < 2.6 l/min/m(2) after induction of anesthesia (75 %) in both groups. There were no significant differences in demographic characteristics, ASA classification, length of surgery, estimated blood loss and the CI during surgery. To maintain the CI within the requested interval, significantly different amounts of crystalloids were needed as compared to colloid (median: 5000 ml vs 1500 ml). In the CRY group, more patients were treated by vasodilatators (40.4 vs 20.7 %).
  
  
  CONCLUSIONS
  The study confirmed that crystalloids and colloids are effective in correcting flow-related perfusion abnormalities. The significant difference between volumes of crystalloids and colloids proved their different characteristics such as unequal distribution between compartments. The expansion of therapeutic algorithm by using vasoactive drugs allows us to avoid adverse events resulting from fluid overload (Tab. 1, Fig. 5, Ref. 35).
authors.forename: P
authors.initials: P
authors.lastname: Szturz
authors.forename: R
authors.initials: R
authors.lastname: Kula
authors.forename: J
authors.initials: J
authors.lastname: Tichy
authors.forename: J
authors.initials: J
authors.lastname: Maca
authors.forename: J
authors.initials: J
authors.lastname: Neiser
authors.forename: P
authors.initials: P
authors.lastname: Sevcik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D017558:Elective Surgical Procedures; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D020896:Hypovolemia / Q000150:complications* / Q000628:therapy*; D007430:Intraoperative Care / Q000379:methods*; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D011446:Prospective Studies; D014570:Urologic Diseases / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D014665:Vasodilator Agents