Related Experiment Video
Updated: Jul 12, 2026
Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock
Published on: October 28, 2022
Targeting individual hemodynamics to maintain renal perfusion during pneumoperitoneum in a porcine model
Sebastian V Demyttenaere1, Ali Taqi, Gerry N Polyhronopoulos
1Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Quebec, Canada.
Background:
Although aggressive fluid hydration prevents a decrease in renal cortical perfusion (RCP) during laparoscopic donor nephrectomy, excess fluid is deleterious. We assessed whether goal-directed fluid administration, based on hemodynamic measures, would maintain RCP during pneumoperitoneum with less fluid loading.
Methods:
In a pilot study of 7 pigs, goal-directed fluid administration was guided by monitoring of stroke volume (SV) by esophageal Doppler measurement. During 15 mmHg CO(2) pneumoperitoneum, a bolus of 5 mL/kg 0.9% NaCl was given when SV decreased to 90% of baseline. Next, 18 pigs were randomized into 3 groups: low fluid (5 mL/kg per hour), high fluid (25 mL/kg per hour) and goal directed. Urine output, heart rate, mean arterial pressure, cardiac output, SV, and RCP were recorded every 15 minutes.
Results:
Pilot data revealed mean RCP (mL/min per 100 g) was maintained (40 vs 39) during pneumoperitoneum using goal-directed therapy. In the randomized study, RCP was decreased in the low fluid group (43 vs 29; P= .02), but maintained in the high (46 vs 40) and goal-directed (42 vs 39) groups. Mean fluid administered in the goal-directed group during pneumoperitoneum was 10 mL/kg and only 3 of 6 of pigs required boluses. Urine output was decreased in all 3 groups.
Conclusion:
A goal-directed strategy during pneumoperitoneum allows for tailored fluid administration and maintains RCP with lower volumes of intravenous fluid.
