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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery

Authors: Luiz Marcelo Sá Malbouisson, João Manoel Silva Jr., Maria José Carvalho Carmona, Marcel Rezende Lopes, Murilo Santucci Assunção, Jorge Luís dos Santos Valiatti, Claudia Marques Simões, José Otavio Costa Auler Jr.

Published in: BMC Anesthesiology | Issue 1/2017

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Abstract

Background

Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study.

Methods

The patients were included in two periods: a first control period (control group; n = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group). We performed 1:1 propensity score matching to ensure the groups were comparable with regard to age, weight, duration of surgery, and type of operation. The primary endpoint was postoperative hospital length of stay.

Results

After matching, 84 patients remained in each group. Baseline characteristics, surgical procedure duration and physiological parameters evaluated at the start of surgery were similar between the groups. The volume of crystalloids (4500 mL [3200-6500 mL] versus 5000 mL [3750-8862 mL]; P = 0.01), the number of blood units infused during the surgery (1.7 U [0.9-2.0 U] versus 2.0 U [1.7-2.6 U]; P = 0.01), the fraction of patients transfused (13.1% versus 32.1%; P = 0.003) and the number of patients receiving mechanical ventilation at 24 h (3.2% versus 9.7%; P = 0.027) were smaller postoperatively in PPV group. Intraoperative PPV-based improved the composite outcome of postoperative complications OR 0.59 [95% CI 0.35-0.99] and reduced the postoperative hospital length of stay (8 days [6-14 days] versus 11 days [7-18 days]; P = 0.01).

Conclusions

In high-risk surgeries, PPV-directed volume loading improved postoperative outcomes and decreased the postoperative hospital length of stay.

Trial Registration

ClinicalTrials.gov Identifier; retrospectively registered- NCT03128190
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Metadata
Title
A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery
Authors
Luiz Marcelo Sá Malbouisson
João Manoel Silva Jr.
Maria José Carvalho Carmona
Marcel Rezende Lopes
Murilo Santucci Assunção
Jorge Luís dos Santos Valiatti
Claudia Marques Simões
José Otavio Costa Auler Jr.
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0356-9

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