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Individualized Fluid Management Using the Pleth Variability Index: A Randomized Clinical Trial.

Marc-Olivier Fischer1, Sandrine Lemoine, Benoît Tavernier

  • 1From the Anesthesiology and Critical Care Medicine Department (M.-O.F., S.L., W.G., G.D., J.-L.H.) the INSERM COMETE 1075 Unit, Orthopedic Department, (C.H.) the Biostatistics Department (J.-J.P.), Normandy University, Caen University Hospital, Caen, France Anesthesiology and Critical Care Medicine Department, Lille University Hospital, Lille, France (B.T., M.H.) Anesthesiology and Intensive Care Medicine Department, Hospital of Catholic Institute of Lille, Saint Philibert Hospital, Lomme, France (C.-E.B., V.C.) Anesthesiology and Critical Care Medicine Department, Rouen University Hospital, Charles Nicolle Hospital, Rouen, France (V.C.) Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France (D.T., E.L.) Research Unit on Simplified Care of Complex Surgical Patients, Jules Verne University of Picardy, Amiens, France (E.L.). Caen University Hospital, Caen, France Caen University Hospital, Caen, France Amiens Picardie University Hospital, Amiens, France Amiens Picardie University Hospital, Amiens, France Lille University Hospital, Lille, France Lille University Hospital, Lille, France Hospital of Catholic Institute of Lille, Lomme, France Clinical Research Department, Caen University Hospital Clinical Research Department, Caen University Hospital Clinical Research Department, Caen University Hospital Clinical Research Department, Hospital of Catholic Institute of Lille Clinical Research Department, Lille University Hospital Clinical Research Department, Lille University Hospital Clinical Research Department, Amiens Picardie University Hospital.

Anesthesiology
|March 25, 2020
PubMed
Summary

Individualized fluid administration using the plethysmographic variability index (PVI) did not reduce hospital stay or complications in intermediate-risk orthopedic surgery patients. This study found no significant difference in outcomes between PVI-guided and standard fluid management strategies.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Surgical Outcomes

Background:

  • Optimizing perioperative fluid management is crucial for improving patient outcomes.
  • Noninvasive hemodynamic monitoring, such as the plethysmographic variability index (PVI), offers a potential tool for guiding fluid administration.
  • The efficacy of PVI-guided fluid strategies in reducing hospital stay and morbidity after intermediate-risk surgery requires further investigation.

Purpose of the Study:

  • To evaluate whether individualized fluid administration strategies, guided by PVI, can decrease postoperative hospital length of stay and morbidity in patients undergoing intermediate-risk surgery.
  • To compare the outcomes of PVI-guided fluid management with standard hemodynamic monitoring protocols.

Main Methods:

  • A multicenter, randomized, nonblinded, parallel-group clinical trial involving adult patients undergoing elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia.
  • Patients were randomized to either PVI-guided fluid management (target PVI < 13%) or standard management (mean arterial pressure > 65 mmHg).
  • The primary outcome was the surgeon-assessed postoperative hospital length of stay. Secondary outcomes included postoperative complications such as cardiac events, renal failure, troponin levels, and lactate measurements.

Main Results:

  • A total of 447 patients were randomized, with 438 included in the analysis. The mean hospital length of stay was similar between the PVI group (6 ± 3 days) and the control group (6 ± 3 days).
  • No significant differences were observed in the rates of serious postoperative cardiac complications (1% vs 1%), acute postoperative renal failure (4% vs 4%), elevated troponin Ic levels (3% vs 2%), or postoperative arterial lactate measurements between the two groups.
  • The theoretical postoperative hospital length of stay also showed no significant difference between the PVI and control groups (P = 0.238).

Conclusions:

  • Fluid administration guided by the plethysmographic variability index did not lead to a shorter hospital stay for intermediate-risk patients undergoing orthopedic surgery.
  • The PVI-guided strategy did not demonstrate a reduction in major postoperative complications compared to standard fluid management.
  • Individualized fluid management using PVI may not be superior to standard protocols for improving short-term outcomes in this patient population.