.: ORİJİNAL ARAŞTIRMA
Traditional Versus Pulse Pressure Variation Based Approach to Intraoperative Fluid Management in Major Surgery: A Prospective Observational Study
Majör Cerrahilerde İntraoperatif Geleneksel Sıvı Yönetimi ile Nabız Basınç Değişimine Dayalı Sıvı Yönetiminin Karşılaştırılması: Prospektif Gözlemsel Bir Çalışma
Turkiye Klinikleri J Anest Reanim. 2025;23(2):58-67
doi: 10.5336/anesthe.2025-110982
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: We hypothesize that pulse pressure variation (PPV)- guided goal-directed fluid management reduces intraoperative hypotension, vasopressor requirements, and improves postoperative recovery in major surgery compared to traditional fluid therapy. Primary outcome: Intraoperative hypotension/vasopressor needs. Secondary outcomes: Post-anesthesia care unit (PACU)/hospital stays, postoperative complications. Material and Methods: In this single-centre prospective observational study, 75 patients (ASA I-III) aged 18-65 years were allocated to Group P (PPV) and Group T (Traditional). Inferior vena cava collapsibility index (IVCCI) was measured preoperatively and postoperatively. In Group P, when PPV was >12%, 250 ml/10 min of fluid was given until it reached ≤12%. If PPV was still ≤12% and hypotension was present, a vasopressor agent was given. Demographic data, oxygen saturation, heart rate, blood pressure, pH, lactate level, urine output, blood loss, fluid administration, and inotropic use were recorded intraoperatively. Postoperative urine output, complications, and the length of PACU/hospital stays were recorded. Results: There were no significant differences between the groups in demographic data, incidence of intraoperative hypotension, and requirement of vasopressor agent (p>0.05). Preoperative and postoperative IVCCI values differed significantly between groups (p=0.016 and p=0.006, respectively). Total volume of fluid intraoperatively was 1425±926.50 ml in Group P and 3260±917.02 ml in Group T (p<0.001). Postoperative pneumonia occurred significantly less frequently in Group P (3.3%) compared to Group T (13.3%) (p<0.001). The length of PACU/hospital stays was shorter in Group P (p=0.003, p=0.038, respectively). Conclusion: Goal-directed fluid management based on PPV reduced intraoperative fluid volume, postoperative pneumonia, and the length of PACU/hospital stays compared to traditional management in major surgery.
Keywords: Goal-directed therapy; inferior vena cava; ultrasonography; pulse pressure; general anesthesia
Objective: We hypothesize that pulse pressure variation (PPV)- guided goal-directed fluid management reduces intraoperative hypotension, vasopressor requirements, and improves postoperative recovery in major surgery compared to traditional fluid therapy. Primary outcome: Intraoperative hypotension/vasopressor needs. Secondary outcomes: Post-anesthesia care unit (PACU)/hospital stays, postoperative complications. Material and Methods: In this single-centre prospective observational study, 75 patients (ASA I-III) aged 18-65 years were allocated to Group P (PPV) and Group T (Traditional). Inferior vena cava collapsibility index (IVCCI) was measured preoperatively and postoperatively. In Group P, when PPV was >12%, 250 ml/10 min of fluid was given until it reached ≤12%. If PPV was still ≤12% and hypotension was present, a vasopressor agent was given. Demographic data, oxygen saturation, heart rate, blood pressure, pH, lactate level, urine output, blood loss, fluid administration, and inotropic use were recorded intraoperatively. Postoperative urine output, complications, and the length of PACU/hospital stays were recorded. Results: There were no significant differences between the groups in demographic data, incidence of intraoperative hypotension, and requirement of vasopressor agent (p>0.05). Preoperative and postoperative IVCCI values differed significantly between groups (p=0.016 and p=0.006, respectively). Total volume of fluid intraoperatively was 1425±926.50 ml in Group P and 3260±917.02 ml in Group T (p<0.001). Postoperative pneumonia occurred significantly less frequently in Group P (3.3%) compared to Group T (13.3%) (p<0.001). The length of PACU/hospital stays was shorter in Group P (p=0.003, p=0.038, respectively). Conclusion: Goal-directed fluid management based on PPV reduced intraoperative fluid volume, postoperative pneumonia, and the length of PACU/hospital stays compared to traditional management in major surgery.
Keywords: Goal-directed therapy; inferior vena cava; ultrasonography; pulse pressure; general anesthesia
ÖZET
Amaç: Nabız basınç değişimi (PPV) rehberliğinde hedefe yönelik sıvı yönetiminin, major cerrahilerde geleneksel sıvı tedavisine kıyasla intraoperatif hipotansiyon ve vazopressör gereksinimini azalttığı ve postoperatif iyileşmeyi arttırdığı hipotezini öne sürüyoruz. Birincil Sonuç: intraoperatif hipotansiyon/vazopresör gereksinimi. İkincil sonuçlar: anestezi sonrası bakım ünitesinde (PACU)/hastanede kalış süresi, postoperatif komplikasyonlar. Gereç ve Yöntemler: Bu tek merkezli prospektif gözlemsel çalışmada, 18-65 yaş arası 75 hasta (ASA I-III) Grup P (PPV) ve Grup T (Geleneksel) olarak ayrıldı. İnferior vena kava kollapsibilite indeksi (IVCCI) preoperatif ve postoperatif olarak ölçüldü. Grup P'de PPV >%12 olduğunda, ≤%12'ye ulaşana kadar 250 ml/10 dk sıvı verildi. Hala PPV ≤%12 ise ve hipotansiyon mevcutsa vazopressör ajan uygulandı. Demografik veriler, parsiyel oksijen satürasyonu, kalp hızı, kan basıncı, pH, laktat düzeyi, idrar çıkışı, kan kaybı, sıvı miktarı ve inotropik kullanımı intraoperatif olarak kaydedildi. Postoperatif idrar çıkışı, komplikasyonlar ve PACU/hastanede kalış süresi kaydedildi. Bulgular: Gruplar arasında demografik veriler, intraoperatif hipotansiyon insidansı ve vazopressör ajan gereksinimi açısından anlamlı fark yoktu (p>0.05). Preoperatif ve postoperatif IVCCI değerlerine bakıldığında gruplar arasında anlamlı farklılık mevcuttu (sırasıyla p=0.016 ve p=0.006). İntraoperatif toplam sıvı hacmi Grup P'de 1425 ± 926.50 ml iken Grup T'de 3260 ± 917.02 ml idi (p<0.001). Postoperatif pnömoni, Grup P'de (%3,3) Grup T'ye (%13,3) kıyasla anlamlı derecede daha az görüldü (p<0,001). PACU/hastanede kalış süreleri Grup P'de daha kısaydı (sırasıyla p=0.003, p=0.038). Sonuç: Majör cerrahilerde PPV'ye dayalı hedefe yönelik sıvı yönetimi intraoperatif sıvı hacmini, postoperatif pnömoniyi ve PACU/hastane kalış sürelerini geleneksel sıvı yönetimine kıyasla azalttı.
Anahtar Kelimeler: Hedefe yönelik tedavi; inferior vena kava; ultrasonografi; nabız basıncı; genel anestezi
Amaç: Nabız basınç değişimi (PPV) rehberliğinde hedefe yönelik sıvı yönetiminin, major cerrahilerde geleneksel sıvı tedavisine kıyasla intraoperatif hipotansiyon ve vazopressör gereksinimini azalttığı ve postoperatif iyileşmeyi arttırdığı hipotezini öne sürüyoruz. Birincil Sonuç: intraoperatif hipotansiyon/vazopresör gereksinimi. İkincil sonuçlar: anestezi sonrası bakım ünitesinde (PACU)/hastanede kalış süresi, postoperatif komplikasyonlar. Gereç ve Yöntemler: Bu tek merkezli prospektif gözlemsel çalışmada, 18-65 yaş arası 75 hasta (ASA I-III) Grup P (PPV) ve Grup T (Geleneksel) olarak ayrıldı. İnferior vena kava kollapsibilite indeksi (IVCCI) preoperatif ve postoperatif olarak ölçüldü. Grup P'de PPV >%12 olduğunda, ≤%12'ye ulaşana kadar 250 ml/10 dk sıvı verildi. Hala PPV ≤%12 ise ve hipotansiyon mevcutsa vazopressör ajan uygulandı. Demografik veriler, parsiyel oksijen satürasyonu, kalp hızı, kan basıncı, pH, laktat düzeyi, idrar çıkışı, kan kaybı, sıvı miktarı ve inotropik kullanımı intraoperatif olarak kaydedildi. Postoperatif idrar çıkışı, komplikasyonlar ve PACU/hastanede kalış süresi kaydedildi. Bulgular: Gruplar arasında demografik veriler, intraoperatif hipotansiyon insidansı ve vazopressör ajan gereksinimi açısından anlamlı fark yoktu (p>0.05). Preoperatif ve postoperatif IVCCI değerlerine bakıldığında gruplar arasında anlamlı farklılık mevcuttu (sırasıyla p=0.016 ve p=0.006). İntraoperatif toplam sıvı hacmi Grup P'de 1425 ± 926.50 ml iken Grup T'de 3260 ± 917.02 ml idi (p<0.001). Postoperatif pnömoni, Grup P'de (%3,3) Grup T'ye (%13,3) kıyasla anlamlı derecede daha az görüldü (p<0,001). PACU/hastanede kalış süreleri Grup P'de daha kısaydı (sırasıyla p=0.003, p=0.038). Sonuç: Majör cerrahilerde PPV'ye dayalı hedefe yönelik sıvı yönetimi intraoperatif sıvı hacmini, postoperatif pnömoniyi ve PACU/hastane kalış sürelerini geleneksel sıvı yönetimine kıyasla azalttı.
Anahtar Kelimeler: Hedefe yönelik tedavi; inferior vena kava; ultrasonografi; nabız basıncı; genel anestezi
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