Outcomes associated with stroke volume variation versus central venous pressure guided fluid replacements during major abdominal surgery.
OBJECTIVE
There is limited data on the impact of perioperative fluid therapy guided by dynamic preload variables like stroke volume variation (SVV) on outcomes after abdominal surgery. We studied the effect of SVV guided versus central venous pressure (CVP) guided perioperative fluid administration on outcomes after major abdominal surgery.


METHODS
Sixty patients undergoing major abdominal surgeries were randomized into two equal groups in this prospective single blind randomized study. In the standard care group, the CVP was maintained at 10-12 mmHg while in the intervention group a SVV of 10% was achieved by the administration of fluids. The primary end-points were the length of Intensive Care Unit (ICU) and hospital stay. The secondary end points were intraoperative lactate, intravenous fluid use, requirement for inotropes, postoperative ventilation and return of bowel function.


RESULTS
The ICU stay was significantly shorter in the intervention group as compared to the control group (2.9 ± 1.15 vs. 5.4 ± 2.71 days). The length of hospital stay was also shorter in the intervention group, (9.9 ± 2.68 vs. 11.96 ± 5.15 days) though not statistically significant. The use of intraoperative fluids was significantly lower in the intervention group than the control group (7721.5 ± 4138.9 vs. 9216.33 ± 2821.38 ml). Other secondary outcomes were comparable between the two groups.


CONCLUSIONS
Implementation of fluid replacement guided by a dynamic preload variable (SVV) versus conventional static variables (CVP) is associated with lesser postoperative ICU stay and reduced fluid requirements in major abdominal surgery.
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Lakshmi
L
Kumar
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Sunil
S
Rajan
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Ramasubramanian
R
Baalachandran
Abdominal surgery; central venous pressure; stroke volume variation