Goal-directed Fluid Therapy Applied To Gastrointestinal Surgery

ObjectiveGoal-directed fluid therapy has been the subject of intensive research recent years. Stroke volume variation (SVV) determined by FloTrac/Vigileo system has been proved to be a reliable predictor to reflect fluid responsiveness precisely. The objective of the study was to investigate the effect of goal-directed fluid therapy guided by Flotrac/Vigileo system on the outcomes in terms of hospital stay, complications such as vomiting, ileus (defecation), anastomotic fistula and pulmonary edema in patients undergoing gastrointestinal surgery.MethodsAfter informed consents were obtained, 80 patients undergoing elective gastrointestinal surgery under general anesthesia were randomly allocated to one of two parallel treatment groups to receive goal-directed fluid therapy (group G) or a conventional fluid therapy (group C). Upon arrival in the operating room the fluid management in both groups was the same: a bolus of compound sodium chloride solution was infused (10 ml/kg) over 30 minutes. Then 6% hydroxyethyl starch (HES) 130/0.4 was infused in group G to maintain SVV≤13% and DO₂≥650ml·min-1·m-2 monitored by FloTrac/Vigileo system, whereas 6%HES or blood products were infused in group C as required. Postoperative fluid administration in both groups was adjusted by vital signs of patients. All patients were followed up and postoperative complications were recorded. We also observed patient's HR, MBP, SpO₂ and serum lactate levels when they were sent to the ward of hospital and at 24 hours after operation. We obtained a blood sample for evaluation of IL-1β, IL-6 and lactate (LAC) from each patient. All samples were obtained before anesthesia (T1), the end of surgery (T2), at 6h (T3), 24h (T4) and 48h (T5) after the surgery and centrifugated at 3000r/min for 10 minutes to detach blood serum, then all serum samples were stored at -80℃until measurement by enzyme linked immunosorbent assay (ELISA).ResultsTotal volume of artificial colloid infused in group G was significantly more than that in group C (1155±338 ml vs. 830±339 ml,P <0.001). The postoperative length of hospital stay was reduced in group G (10.35±1.98 days vs. 12.58±2.06 days,P <0.001). The actual episodes of vomiting were 6 in group G versus 15 in group C (P <0.05),and there was 1 case postoperative ileus in group G versus 7 in group C (P <0.05). The serum IL-1βin group G were statistically lower than than that in group G at 6 hrs and 24 hrs after surgery, respectively (P <0.05). Compared with group C, the concentrations of serum IL-6 in group G were significantly lower at 6 hrs and 48 hrs after surgery, respectively (P < 0.05).ConclusionIntraoperative goal-directed fluid therapy may not only reduce the incidence of post-operative complications and duration of hospital stay,but also decrease the serum lactate levels and serum IL-1βand IL-6 concentrations.