RESUMEN
Background: Maximizing the stroke volume (SV) as measured by Trans-oesophageal Doppler (TED) optimizes preload, & is a goal-directed fluid therapy technique that has been used in a variety of clinical settings. Masimo® Plethysmograph variability Index (PVI) is a reliable, safe & noninvasive tool to guide fluid management. PVI is an automated measure of the dynamic change in the perfusion index (PI) that occurs during a respiratory cycle. This study was designed to determine whether PVI, measured using finger co-oximetry is an efficient predictor of fluid responsiveness in low-risk patients undergoing elective major abdominal surgery. Subjects and Methods: 60 ASA I-II patients of either sex, 25-60 years old, undergoing major abdominal surgery were enrolled in this study. A Masimo® Radical-7 Pulse Co-Oximeter probe & a Cardio Q TED probe were applied to each patient. In all patients, a fluid bolus of 500 ml of 130/0.4 tetrastarch colloid solution was administered rapidly via pressurized IV infusion. Maintenance & deficits were calculated routinely. If the SV decreased by 10%, a 250-mL bolus of colloid was given via fast infusion. Patients’ demography, TED-derived measurements: (SV & Flow Time corrected (FTc)), Masimo®-derived measurements: (PVI & PI), HR and MAP were all collected and statistically analyzed. Measurements were done at five minutes post-induction T1, Ten minutes after volume expansion (500 ml colloid) T2, If the SV decreased by 10%, (guided by TED) T3, Then 250 ml colloid is given. Ten minutes after a 250-ml colloid bolus T4. Results: A significant difference was found in FTc, SV, PI & PVI in T1 vs. T2 & T3 vs. T4 (P=0.001). There was a significant difference in PI & PVI between responders & non-responders for the 1st bolus (P<0.05) and in SV & PVI in subsequent boluses (P<0.01). There was no significant difference between percent changes of SV and PVI at T3 & T4. Conclusions: Plethysmograph Variability Index (PVI) measured by Masimo® Co-Oximeter is an efficient predictor of fluid responsiveness as SV measured by TED in low risk patients undergoing elective major surgery.
RESUMEN
Background: Perioperative fluid management is essential to the practice of anaesthesia. Outcomes may be improved if fluid therapy is individualized according to the patient's fluid responsiveness. Pulse-induced continuous cardiac output (PiCCO) monitor is an invasive device that quantifies several parameters, including cardiac output (CO), stroke volume variation (SVV) and extravascular lung water (EVLW). Trans-oesophageal Doppler monitoring (TED) is another minimally invasive form and has the benefit of providing beat to beat analysis. Aim of Work: We designed this prospective, randomized comparative study to evaluate the use of PiCCO monitor from the fluid and haemodynamic point of view in comparison to TED monitor in order to maintain an adequate circulatory volume ensuring end-organ perfusion and oxygen delivery. Patients and Methods: This study was performed on 72 patients of either sex (ASA I-II), undergoing major abdominal surgery. Patients were randomly allocated into two groups; PiCCO group (n=36); where fluid management was guided by SVV & colloid boluses were given to maintain SVV below 10% and TED group (n=36); where fluid management was guided by (systolic flow time corrected for heart rate) (FTc) & colloid was infused when the (FTc) ˂ 0.35 second, the fluid challenge would be repeated until FTc raised ˃ 0.40 second with no change in SV. Laboratory parameters of organ hypoperfusion in perioperative period were recorded as well as the number of postoperative complications, mortality and length of ICU stay. Results: PiCCO group received more intraoperative colloids (P=0.001) and had lower incidence of hypotensive events (P=0.001). Postoperative lactate levels were lower in PiCCO group (P=0.04). PiCCO group showed fewer numbers of patients developed complications & overall number of postoperative complications (P=0.01). It also showed shorter duration of ICU length of stay (P=0.01). No mortality was recorded in both groups. Conclusions: During major abdominal surgery; intraoperative fluid optimization using PiCCO monitor showed more haemodynamic stability and was associated with a lower incidence of postoperative complications, organ dysfunction and infectious complications with a tendency to decrease the ICU length of stay in comparison to TED monitor.