title: Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position: A Cohort Study.
abstract: METHODS
  A retrospective observational study.
  
  
  OBJECTIVE
  The aim of this study was to test whether a goal-directed fluid therapy (GDFT) protocol, based on stroke volume variation (SVV), applied in major spine surgery performed in the prone position, would be effective in reducing peri-operative red blood cells transfusions.
  
  
  BACKGROUND
  Recent literature shows that optimizing perioperative fluid therapy is associated with lower complication rates and faster recovery.
  
  
  METHODS
  Data from 23 patients who underwent posterior spine arthrodesis surgery and whose intraoperative fluid administration were managed with the GDFT protocol were retrospectively collected and compared with data from 23 matched controls who underwent the same surgical procedure in the same timeframe, and who received a liberal intraoperative fluid therapy.
  
  
  RESULTS
  Patients in the GDFT group received less units of transfused red blood cells (primary endpoint) in the intra (0 vs. 2.0, P = 0.0 4) and postoperative period (2.0 vs. 4.0, P = 0.003). They also received a lower amount of intraoperative crystalloids, had fewer blood losses, and lower intraoperative peak lactate. In the postoperative period, patients in the GDFT group had fewer pulmonary complications and blood losses from surgical drains, needed less blood product transfusions, had a shorter intensive care unit stay, and a faster return of bowel function. We found no difference in the total length of stay among the two groups.
  
  
  CONCLUSIONS
  Our study shows that application of a GDFT based on SVV in major spine surgery is feasible and can lead to reduced blood losses and transfusions, better postoperative respiratory performance, shorter ICU stay, and faster return of bowel function.
  
  
  METHODS
  3.
authors.affiliation: Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Maria Renata
authors.initials: MR
authors.lastname: Bacchin
authors.affiliation: Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Chiara Marta
authors.initials: CM
authors.lastname: Ceria
authors.affiliation: Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Giannone
authors.affiliation: Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ghisi
authors.affiliation: Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Stagni
authors.affiliation: Deparment of Spine Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Greggi
authors.affiliation: Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonarelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016684:Prone Position; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013131:Spine / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology*; D055815:Young Adult