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Goal-directed fluid therapy guided by Plethysmographic Variability Index (PVI) versus conventional liberal fluid
Preethy J Mathew1, Sanjay Sharma1, Neerja Bhardwaj1
1Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Pulse vascular imaging (PVI)-guided fluid therapy in pediatric abdominal surgery significantly reduced fluid administration and improved patient recovery. This approach led to faster bowel function recovery and less hemodilution compared to liberal fluid strategies.
Area of Science:
- Pediatric Anesthesiology
- Surgical Fluid Management
- Hemodynamic Monitoring
Background:
- Pulse vascular imaging (PVI) is a validated predictor of fluid responsiveness in pediatric patients.
- Limited evidence exists on PVI's utility in guiding intraoperative fluid therapy for pediatric abdominal surgery.
- This study addresses the gap by evaluating PVI-guided fluid therapy in this specific surgical context.
Purpose of the Study:
- To assess the impact of PVI-guided fluid therapy on intraoperative fluid administration in children undergoing elective abdominal surgery.
- To evaluate the effect of PVI-guided fluid therapy on postoperative biochemical markers and recovery profiles.
- To compare outcomes between a goal-directed fluid therapy (GDT) group using PVI and a conventional liberal fluid group.
Main Methods:
- A randomized clinical trial involving 42 pediatric patients (6 months-3 years) scheduled for open bowel surgery.
- Patients were assigned to either a liberal fluid group or a GDT group targeting PVI <13.
- Primary outcome: intraoperative fluid volume. Secondary outcomes: postoperative lactate, base excess, hematocrit, bowel function recovery, and hospital stay duration.
Main Results:
- The GDT group received significantly less intraoperative fluid (24.1 mL/kg) compared to the liberal group (37.0 mL/kg) (p < 0.001).
- Postoperative hemoglobin was higher in the GDT group (9.2 g%) versus the liberal group (8.1 g%) (p = 0.008), indicating less hemodilution.
- Bowel function recovery was significantly faster in the GDT group (36.5 hours) than the liberal group (58.2 hours) (p < 0.001).
Conclusions:
- Intraoperative PVI-guided fluid therapy effectively reduces crystalloid administration in pediatric open bowel surgery.
- This PVI-guided approach results in improved postoperative bowel function recovery.
- PVI-guided fluid management also minimizes postoperative hemodilution compared to liberal fluid strategies.
Background:
PVI has been shown to be an accurate predictor of fluid responsiveness in paediatric patients. Evidence regarding the role of PVI to guide intraoperative fluid therapy in paediatric abdominal surgery is lacking. We aimed to assess the effect of PVI-guided fluid therapy on the volume of intraoperative fluids administered and post-operative biochemical and recovery profile in children undergoing elective abdominal surgery.
Methods:
42 children, 6 months-3 years scheduled for elective open bowel surgery were randomised to receive either 'conventional liberal intraoperative fluids' (liberal group) or 'goal-directed intraoperative fluids' (GDT group). PVI <13 was targeted in the GDT group. The primary outcome was the volume of intraoperative fluids administered. Postoperative serum lactate, base excess, hematocrit, recovery of bowel function and duration of postoperative hospital stay were the secondary outcomes.
Results:
The mean fluid administered intra-operatively was significantly lower in the GDT group as compared to the liberal group (24.1 ± 9.6 mL/kg vs 37.0 ± 8.9 mL/kg, p < 0.001). The postoperative hemoglobin concentration (g%) was significantly lower in the liberal group as compared to the GDT group (8.1 ± 1.3 vs 9.2 ± 1.4, p = 0.008). Recovery of bowel function (hours) was significantly delayed in the liberal group as compared to the GDT group (58.2 ± 17.9 vs 36.5 ± 14.1, p < 0.001).
Conclusion:
Intraoperative PVI-guided fluid therapy significantly reduces the volume of intravenous crystalloids administered to children undergoing open bowel surgery. These children also had faster recovery of bowel function and less hemodilution in the immediate postoperative period, compared to those who received liberal intraoperative fluid therapy.
Type Of Study:
Randomized Clinical Trial.
Level Of Evidence:
Treatment Study (LEVEL 1).
