The Effect of Targeted Fluid Therapy with PVI on Acute Kidney Injury in Laparoscopic Colorectal Surgery

Abstract

Objectives: Laparoscopic approaches are preferred for colorectal surgeries because they have proven advantages in the literature. However, increased intra-abdominal pressure and hypo/hypervolemia adversely affect tissue perfusion. In this study, we aimed to improve postoperative outcomes with targeted fluid therapy using Pleth variability index (PVI) and to demonstrate its effect on kidneys using neutrophil gelatinase associated lipocalin (NGAL). Materials and Methods: This study was a prospective randomized control, single-centred study. Twenty-nine patients who underwent elective laparoscopic colorectal surgery were included. Patients were randomized into 2 groups, as Group-1 receiving targeted fluid therapy with PVI (n=15) and Group 2 receiving conventional fluid therapy (n=14). 500 mL of crystalloid bolus and 2 mL/kg/hour of maintenance fluid were applied to the PVI group. When the PVI>14%, a 250 mL of crystalloid bolus was administered. In the group receiving, conventional fluid therapy “4-2-1 rule” was used. Plasma NGAL samples were received at pre-insufflation (T0), post-insufflation 6th (T1) and 12th (T2) hours. Results: When the given fluids were compared between the groups, we detected significantly diminished results for Group 1 (p<0.001). The increase between basal NGAL and 6th hour, 12th hour NGAL were statistically significant in both groups (p<0.05). While there were no postoperative complications in Group 1, respiratory complications were seen in 2 patients and wound infection in 1 patient in Group 2. Conclusion: Targeted fluid therapy with PVI had no significant effect on NGAL associated acute kidney injury. Nevertheless, there were no postoperative complications in these patients. We think that fluid therapy with PVI can be used in laparoscopic colorectal surgeries to avoid complications caused by fluid load.

Keywords

• Laparoscopic Colorectal Surgery
• Acute Kidney Injury
• PVI
• NGAL

Ethical Statement

Ethical approval was obtained from Ankara University Faculty of Medicine, Clinical Research Ethics Committee (decision no: 15-823-16, date: 10.10.2016).

Laparoskopik Kolorektal Cerrahide PVI ile Hedefe Yönelik Sıvı Tedavisinin Akut Böbrek Hasarı Üzerine Etkisi

Abstract

Amaç: Kolorektal cerrahilerde, laparoskopik uygulamalar, literatürde kanıtlanmış birçok avantajı olması nedeniyle tercih edilmektedir. Ancak intraabdominal basınç artışı ve hipo/hipervolemi doku perfüzyonunu olumsuz etkilemektedir. Bu çalışmada, Pleth değişkenlik indeksi (Pleth variability index-PVI) monitörizasyonu ile hedefe yönelik sıvı tedavisi yaparak hem postoperatif sonuçları iyileştirmeyi hem de nötrofil jelatinaz ilişkili lipokalini (NGAL) kullanarak bu yaklaşımın böbrekler üzerindeki etkisini göstermeyi amaçladık. Gereç ve Yöntem: Bu çalışma tıp fakültemizin genel cerrahi ameliyathanelerinde, prospektif randomize kontrollü, tek merkezli olarak gerçekleştirildi. Elektif laparoskopik kolorektal cerrahi geçirmiş, 29 hasta dahil edildi. Hastalar, Grup 1 (n=15) PVI ile hedefe yönelik sıvı tedavisi alanlar ve Grup 2 (n=14), konvansiyonel sıvı tedavisi alanlar şeklinde randomize edildi. Genel anestezi indüksiyonu sonrası PVI grubuna 500 mL kristaloid bolusu ve 2 mL/kg/saat idame sıvı uygulandı. PVI>%14 olduğunda 250 mL kristaloid bolusu verildi. Standart sıvı tedavisi alan grupta ise 4-2-1 kuralına göre konvansiyonel sıvı tedavisi yapıldı. Bütün hastalarda plazma NGAL örnekleri insuflasyon öncesi (T0), insuflasyon sonrası 6. (T1) ve 12. (T2) saatlerde alındı. Bulgular: Gruplar arasındaki verilen sıvılar karşılaştırıldığında Grup 1’de verilen sıvı volümü anlamlı olarak daha az bulundu (p<0,001). NGAL değerlerindeki artış her iki grupta benzerdi. Bazal NGAL ile 6. saat NGAL arasındaki artış ve bazal NGAL ile 12. saat NGAL arasındaki artış istatistiksel olarak anlamlı bulundu (p<0,05). Grup 1’de postoperatif hiç komplikasyon izlenmezken Grup 2’de 2 hastada solunumsal komplikasyonlar, 1 hastada yara yeri enfeksiyonu görüldü. Sonuç: PVI ile hedefe yönelik sıvı tedavisinin, NGAL ile gösterilebilen akut böbrek hasarı üzerine, belirgin etkisi olmadı. Bununla birlikte bu hastalarda postoperatif komplikasyon görülmedi. Laparoskopik kolorektal cerrahilerde PVI monitörizasyonu ile sıvı tedavisinin, sıvı yükünün getirdiği komplikasyonlardan kaçınmak amacı ile kullanılabileceğini düşünmekteyiz.

Keywords

• Laparoskopik Kolorektal Cerrahi
• Akut Böbrek Hasarı
• PVI
• NGAL

Ethical Statement

Ankara Üniversitesi Tıp Fakültesi, Klinik Araştırmalar Etik Kurulu’ndan etik onay (karar no: 15-823-16, tarih: 10.10.2016) alınmıştır.

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