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

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Goal Directed Fluid Therapy (GDFT) using the non-invasive Pleth Variability Index (PVI) showed no difference in complications or hospital stay compared to esophageal Doppler in major abdominal surgery. PVI is an acceptable alternative for GDFT.

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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.