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Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A
Janani Gopal1, Shashi Srivastava1, Nidhi Singh1
1Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Asian Journal of Neurosurgery
|December 28, 2023
Summary
Pulse pressure variance (PPV)-guided fluid management reduced intraoperative fluid needs and hypotension in neurosurgery patients compared to central venous pressure (CVP)-guided therapy. This dynamic approach ensures better hemodynamic stability without compromising brain conditions.
Area of Science:
- Neurosurgery
- Anesthesiology
- Critical Care Medicine
Background:
- Fluid management in neurosurgery is critical to prevent secondary brain injury.
- Static variables like central venous pressure (CVP) are unreliable for assessing volume status.
- Dynamic variables offer a more reliable approach to fluid responsiveness.
Purpose of the Study:
- To compare intraoperative fluid requirements between CVP-guided and pulse pressure variance (PPV)-guided fluid management.
- To evaluate hemodynamic stability and brain relaxation during supratentorial tumor surgeries.
Main Methods:
- Prospective, randomized, double-blind, single-center trial with 72 adult patients.
- Two groups: CVP-guided (target CVP > 8 mmHg) and PPV-guided (target PPV < 13%).
- Both groups received maintenance fluids; CVP group also received hourly replacement of intraoperative losses.
Main Results:
- The PPV group received significantly less intraoperative fluid (3,540 ± 740 mL) than the CVP group (4,340 ± 1,010 mL).
- Hypotension incidence was lower in the PPV group (0%) compared to the CVP group (11.1%).
- Brain relaxation, lactate levels, edema, and postoperative nausea/vomiting were comparable between groups.
Conclusions:
- PPV-guided fluid management requires less intraoperative fluid and improves hemodynamic stability.
- This dynamic approach is effective in supratentorial tumor surgeries without negatively impacting brain conditions or perfusion.
