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Goal-Directed Fluid Therapy Using Pulse Pressure Variation in Thoracic Surgery Requiring One-Lung Ventilation: A
Giovanni Punzo1, Giovanna Beccia1, Chiara Cambise1
1Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Fluid management using pulse pressure variation (PPV) in thoracic surgery did not improve oxygen levels or reduce complications. This approach led to increased fluid administration without clear clinical benefits compared to standard methods.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Intraoperative fluid management strategies are crucial for surgical outcomes.
- Pulse pressure variation (PPV) has shown promise in optimizing fluid administration.
- Its role in thoracic surgery with one-lung ventilation remains unestablished.
Purpose of the Study:
- To evaluate the efficacy and safety of PPV-guided fluid management.
- To compare PPV-guided fluid management with conventional methods in thoracic surgery.
- To assess the impact on pulmonary gas exchange and postoperative complications.
Main Methods:
- Randomized trial comparing PPV-guided fluid management versus conventional hemodynamic parameters.
- Uniportal video-assisted thoracic surgery for pulmonary lobectomy.
- Primary outcome: post-extubation partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio.
Main Results:
- No significant difference in PaO2/FiO2 ratio between groups (p=0.51).
- PPV group received significantly more crystalloids (p=0.01) and colloids (p=0.002).
- No differences in extubation time, postoperative pulmonary complications, or hospital stay.
Conclusions:
- PPV-guided fluid management does not enhance pulmonary gas exchange in thoracic surgery.
- This strategy does not appear to offer clinical benefits over conventional fluid management.
- PPV-guided management resulted in increased fluid administration.
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