Goal-Directed Fluid Therapy Based on Pulse-Pressure Variation Compared with Standard Fluid Therapy in Patients Undergoing Complex Spine Surgery: A Randomized Controlled Trial
Issued Date
2022-06-01
Resource Type
ISSN
19761902
eISSN
19767846
Scopus ID
2-s2.0-85134133023
Journal Title
Asian Spine Journal
Volume
16
Issue
3
Start Page
352
End Page
360
Rights Holder(s)
SCOPUS
Bibliographic Citation
Asian Spine Journal Vol.16 No.3 (2022) , 352-360
Suggested Citation
Wongtangman K., Wilartratsami S., Hemtanon N., Tiviraj S., Raksakietisak M. Goal-Directed Fluid Therapy Based on Pulse-Pressure Variation Compared with Standard Fluid Therapy in Patients Undergoing Complex Spine Surgery: A Randomized Controlled Trial. Asian Spine Journal Vol.16 No.3 (2022) , 352-360. 360. doi:10.31616/asj.2020.0597 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85802
Title
Goal-Directed Fluid Therapy Based on Pulse-Pressure Variation Compared with Standard Fluid Therapy in Patients Undergoing Complex Spine Surgery: A Randomized Controlled Trial
Author's Affiliation
Other Contributor(s)
Abstract
Study Design: Prospective, randomized, controlled study. Purpose: To determine whether the use of goal-directed fluid therapy (GDT) guided by pulse-pressure variation (PPV) and fluid management protocol can reduce intraoperative hypotension, blood transfusion requirements, and postoperative complications in adults undergoing complex spine surgery. Overview of Literature: Complex spine surgeries involve a significant risk of blood loss and intraoperative hypotension. Previous studies showed that GDT reduces intraoperative hypotension and postoperative complications in these surgery types; however, limited information exists about GDT guided by PPV. Methods: Sixty adults (18–70 years) patients undergoing complex spine surgeries at Siriraj Hospital, Mahidol University, Thailand were enrolled. Patients were allocated to two groups (30 patients in each) using computer-generated randomization. Intraoperative fluid and vasopressor were administrated via either GDT or standard care. The GDT algorithm used PPV and fluid protocol as the primary tool to guide hemodynamic management. The incidences and episodes of perioperative hypotension were measured as the outcomes. Results: Fifty-seven patients were analyzed (three patients in the GDT group were excluded). The baseline characteristics and surgical procedures of the two groups did not differ significantly. The prevalence of intraoperative hypotension was 80.0% for the control group and 66.7% for the GDT group (p =0.25). Two episodes (1–3) of intraoperative hypotension occurred in the control group, and one episode (0–3) occurred in the GDT group; the difference was not significantly different (p =0.57). The intraoperative blood transfusion requirements and postoperative complications were similar in both the groups. In the subgroup analysis, patients with intraoperative hypotension exhibited a higher incidence of postoperative bowel dysfunction. Conclusions: PPV-guided GDT and fluid protocol, as compared with standard practice, did not show significant advantages with respect to intraoperative hypotension, blood transfusion, or postoperative complications in patients undergoing complex spine surgery in the prone position