Pleth variability index as a tool for volume optimization during open abdominal surgery

2014 ◽  
Vol 31 ◽  
pp. 44
Author(s):  
H. Bahlmann ◽  
R. Hahn ◽  
L. Nilsson
Keyword(s):  
Abdominal Surgery ◽  
Pleth Variability Index ◽  
Open Abdominal Surgery ◽  
Variability Index

PLETH VARIABILITY INDEX-GUIDED FLUID THERAPY LOWERS POST-OPERATIVE LACTATE LEVELS IN DOGS UNDERGOING ELECTIVE ABDOMINAL SURGERY: A RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 44 (01) ◽  
pp. 7-14
Author(s):  
Chun-Hsiang Hu ◽  
Tien-Huan Hsu ◽  
Kuan-Sheng Chen ◽  
Wei-Ming Lee ◽  
Hsien-Chi Wang
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Fluid Management ◽  
Tissue Perfusion ◽  
Control Group ◽  
Pleth Variability Index ◽  
Elective Abdominal Surgery ◽  
Variability Index ◽  
Lactate Levels

To evaluate the hemodynamic optimization effect of pleth variability index (PVI)-guided fluid therapy during abdominal surgery on tissue perfusion, 19 client-owned dogs that underwent elective abdominal surgery were randomized into control ([Formula: see text]) and PVI ([Formula: see text]) groups. In the control group, perioperative fluid management was based on the 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats. In the PVI group, the fluid rate was maintained based on basic daily requirements. If PVI was higher than 15% for [Formula: see text][Formula: see text]min, 3–5[Formula: see text]mL/kg of crystalloid fluid bolus was infused. The tissue perfusion indicator, lactate levels, was measured at the time of intubation, extubation, and 6, 12 and 24[Formula: see text]h postoperatively. There were no significant differences in total and average fluid infused between control and PVI groups. The control group had significantly higher lactate levels than that of the PVI group at 12[Formula: see text]h postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]) and overall postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]). The control group revealed more profound hemodilution, as indicated by significantly decreased postoperative blood urea nitrogen (BUN), creatinine, and total protein. PVI-guided fluid therapy lowers lactate levels after elective abdominal surgery in dogs. Therefore, based on the result of this study PVI may provide customized fluid therapy to improve tissue perfusion and avoid unnecessary fluid overload.

scholarly journals The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guido Mazzinari ◽  
◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Goran Hedenstierna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Las Vegas ◽  
Cohort Analysis ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Driving Pressure ◽  
Postoperative Pulmonary Complications ◽  
Open Abdominal Surgery

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P <  0.001 versus 1.05 [95%CI 1.05 to 1.05], P <  0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P <  0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P <  0.001 versus 1.07 [95%CI 1.05 to 1.10], P <  0.001; risk difference 0.05 [95%CI 0.030.07], P <  0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

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