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Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial.

Publication ,  Journal Article
Correa-Gallego, C; Tan, KS; Arslan-Carlon, V; Gonen, M; Denis, SC; Langdon-Embry, L; Grant, F; Kingham, TP; DeMatteo, RP; Allen, PJ; Fischer, M ...
Published in: J Am Coll Surg
August 2015

BACKGROUND: The optimal perioperative fluid resuscitation strategy for liver resections remains undefined. Goal-directed therapy (GDT) embodies a number of physiologic strategies to achieve an ideal fluid balance and avoid the consequences of over- or under-resuscitation. STUDY DESIGN: In a prospective randomized trial, patients undergoing liver resection were randomized to GDT using stroke volume variation as an end point or to standard perioperative resuscitation. Primary outcomes measure was 30-day morbidity. RESULTS: Between 2012 and 2014, one hundred and thirty-five patients were randomized (GDT: n = 69; standard perioperative resuscitation: n = 66). Median age was 57 years and 56% were male. Metastatic disease comprised 81% of patients. Overall (35% GDT vs 36% standard perioperative resuscitation; p = 0.86) and grade 3 morbidity (28% GDT vs 18% standard perioperative resuscitation; p = 0.22) were equivalent. Patients in the GDT arm received less intraoperative fluid (mean 2.0 L GDT vs 2.9 L standard perioperative resuscitation; p < 0.001). Perioperative transfusions were required in 4% (6% GDT vs 2% standard perioperative resuscitation; p = 0.37) and boluses in the postanesthesia care unit were administered to 24% (29% GDT vs 20% standard perioperative resuscitation; p = 0.23). Mortality rate was 1% (2 of 135 patients; both in GDT). On multivariable analysis, male sex, age, combined procedures, higher intraoperative fluid volume, and fluid boluses in the postanesthesia care unit were associated with higher 30-day morbidity. CONCLUSIONS: Stroke volume variation-guided GDT is safe in patients undergoing liver resection and led to less intraoperative fluid. Although the incidence of postoperative complications was similar in both arms, lower intraoperative resuscitation volume was independently associated with decreased postoperative morbidity in the entire cohort. Future studies should target extensive resections and identify patients receiving large resuscitation volumes, as this population is more likely to benefit from this technique.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

August 2015

Volume

221

Issue

2

Start / End Page

591 / 601

Location

United States

Related Subject Headings

  • Water-Electrolyte Balance
  • Venous Pressure
  • Surgery
  • Stroke Volume
  • Single-Blind Method
  • Resuscitation
  • Prospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Middle Aged
 

Citation

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Correa-Gallego, C., Tan, K. S., Arslan-Carlon, V., Gonen, M., Denis, S. C., Langdon-Embry, L., … Fischer, M. (2015). Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. J Am Coll Surg, 221(2), 591–601. https://doi.org/10.1016/j.jamcollsurg.2015.03.050
Correa-Gallego, Camilo, Kay See Tan, Vittoria Arslan-Carlon, Mithat Gonen, Stephanie C. Denis, Liana Langdon-Embry, Florence Grant, et al. “Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial.J Am Coll Surg 221, no. 2 (August 2015): 591–601. https://doi.org/10.1016/j.jamcollsurg.2015.03.050.
Correa-Gallego C, Tan KS, Arslan-Carlon V, Gonen M, Denis SC, Langdon-Embry L, et al. Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. J Am Coll Surg. 2015 Aug;221(2):591–601.
Correa-Gallego, Camilo, et al. “Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial.J Am Coll Surg, vol. 221, no. 2, Aug. 2015, pp. 591–601. Pubmed, doi:10.1016/j.jamcollsurg.2015.03.050.
Correa-Gallego C, Tan KS, Arslan-Carlon V, Gonen M, Denis SC, Langdon-Embry L, Grant F, Kingham TP, DeMatteo RP, Allen PJ, D’Angelica MI, Jarnagin WR, Fischer M. Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial. J Am Coll Surg. 2015 Aug;221(2):591–601.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

August 2015

Volume

221

Issue

2

Start / End Page

591 / 601

Location

United States

Related Subject Headings

  • Water-Electrolyte Balance
  • Venous Pressure
  • Surgery
  • Stroke Volume
  • Single-Blind Method
  • Resuscitation
  • Prospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Middle Aged