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Pleth Variability Index Guided Volume Optimisation in Major Gynaecologic Surgery.
Ummahan Dalkilinc Hokenek1, Harika Kosluk Gurler1, Ayten Saracoglu2
1Department of Anaesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lutfi Kirdr City Hospital, Istanbul, Turkey.
Summary
Goal-directed fluid management using the pleth variability index (PVI-GDFM) is as safe as conventional fluid management (CFM) for surgeries like TAH-BSO. This PVI approach optimizes fluid administration, potentially reducing crystalloid use and improving patient outcomes.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Surgical Patient Management
- Critical Care Medicine
Background:
- Optimizing intraoperative fluid management is crucial for patient outcomes.
- Conventional fluid management (CFM) lacks precision in guiding fluid administration.
- Pleth variability index (PVI) offers a dynamic, real-time measure of fluid responsiveness.
Purpose of the Study:
- To compare the safety and efficacy of PVI-guided goal-directed fluid management (GDFM) against CFM.
- To evaluate fluid management strategies during elective total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO).
Main Methods:
- A randomized controlled trial involving 78 patients undergoing elective TAH-BSO.
- Patients were assigned to either PVI-GDFM or CFM groups.
- Fluid therapy was guided by PVI thresholds or standard protocols, with interventions for hypotension or low PVI response.
Main Results:
- No significant differences in age, BMI, urine output, bleeding, hospital stay, or complication rates between groups.
- The PVI group demonstrated shorter operational times and reduced crystalloid administration (p<0.001).
- Postoperative base excess (BE) levels showed significantly less variation in the PVI group (p<0.001).
Conclusions:
- PVI-GDFM is a safe alternative to CFM for intraoperative fluid management in TAH-BSO.
- PVI-GDFM may lead to more efficient fluid administration and better physiological stability (indicated by BE).
- Further research could explore broader applications of PVI-GDFM in various surgical settings.
