Two-stage goal-directed therapy protocol for non-donor open hepatectomy: an interventional before-after study

Area of Science:

• Anesthesiology
• Surgical Oncology
• Critical Care Medicine

Background:

• Hemodynamic management in hepatectomy traditionally uses low central venous pressure (L-CVP) with fluid restriction/resuscitation.
• High stroke volume variation (SVV) has emerged as a potential alternative to L-CVP for minimizing blood loss during liver surgery.

Purpose of the Study:

• To evaluate the efficacy of a novel SVV-based goal-directed therapy (GDT) protocol in reducing intraoperative blood loss during hepatectomy.
• To compare blood loss in patients managed with SVV-guided GDT versus conventional L-CVP-assisted methods.

Main Methods:

• A before-after comparative study design was employed, including a control group (L-CVP) and an intervention group (SVV-guided GDT).
• The GDT protocol utilized SVV, cardiac index, and mean arterial pressure, with target SVV ranges of ≥13% before and ≤12% after resection.
• Blood loss <400 mL was the primary endpoint, assessed using multiple regression analysis for associated factors.

Main Results:

• The SVV-guided GDT group (50 patients) experienced significantly less blood loss (median 220 mL) compared to the control group (66 patients).
• 72% of patients in the GDT group achieved blood loss <400 mL, exceeding the 50% threshold (P < 0.001).
• GDT-guided fluid optimization post-resection reduced intraoperative fluid balance compared to conventional therapy.

Conclusions:

• SVV-guided GDT represents a promising strategy for reducing blood loss during hepatectomy.
• This hemodynamic management approach may offer advantages over conventional L-CVP-assisted techniques.
• Factors such as GDT application, epidural anesthesia, operative time, and hydroxyethyl-starch volume were associated with blood loss.