Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial.

Area of Science:

• Anesthesiology
• Surgical Critical Care
• Hemodynamic Monitoring

Background:

• Goal Directed Fluid Therapy (GDFT) is crucial for optimizing outcomes in major abdominal surgery.
• The non-invasive Pleth Variability Index (PVI) offers a potential alternative for guiding GDFT.
• Limited research exists on PVI's impact on clinical outcomes compared to traditional methods.

Purpose of the Study:

• To compare the efficacy of intraoperative GDFT guided by PVI versus esophageal Doppler.
• To evaluate the incidence of postoperative complications and length of hospital stay.
• To determine if PVI is a viable alternative to esophageal Doppler in major abdominal surgery.

Main Methods:

• A randomized controlled trial involving 150 patients undergoing major open abdominal surgery.
• Patients were allocated to either PVI-guided GDFT or esophageal Doppler-guided GDFT.
• Complications and length of hospital stay were assessed by blinded observers.

Main Results:

• No significant difference in the total number of complications between the PVI group (64) and the Doppler group (70).
• Median length of hospital stay was similar in both groups (8.0 days).
• The study included 146 patients for final analysis, with a median surgery duration of 3 hours.

Conclusions:

• Intraoperative GDFT using PVI did not result in a different clinical outcome compared to esophageal Doppler.
• PVI is a suitable alternative to esophageal Doppler for guiding fluid therapy during major open abdominal surgery.
• This finding supports the broader adoption of non-invasive hemodynamic monitoring techniques.