Investıgatıon Of The Pvi (Pleth Variability Index) Controlled Goal Directed Fluid Therapy On Tissue Perfusion In Patient Undergoing Sleeve Gastrectomy

Abstract

In this study, the aim is to investigate the effects of PVI controlled targeted fluid therapy on tissue perfusion in patients who underwent laparoscopic sleeve gastrectomy. Plasma lactate level was evaluated retrospectively to assess the effect of these fluid treatments on tissue perfusion. In our study, group treated with PVI controlled targeted fluid therapy was defined as group I, and group with standard fluid therapy was designated as Group II. In group I, fluid therapy was applied with a PVI ratio of 14%. In group II, fluid therapy was applied as standard 4-6 mL/kg/h. In case of hypotension (<65 mmHg) or in case of bleeding, bolus colloid was applied in both groups. In both groups, arterial blood samples were taken at 6, 12, 18, 24, 36, 48 hours of skin incision every hour and post-operatively during surgery. When the lactate levels between the groups were compared, intraoperative 60th min (1,25 ± 0,48-1,57 ± 0,51) and post-operative 48th hour (0,73 ± 0,27- 0.91 ± 0.36) were found to be significantly lower in Group I. The mean crystalloid volume applied to group I was 734,33 ± 85,20 mL, whereas it was 1214,7 ± 231,43 mL applied to Group II and this difference was significant. The total volume of fluid administered to group I was 1242,667 ± 283,073 mL and group II was 1739,667 ± 303,888 mL, and this difference was significant. In conclusion, we concluded that the use of targeted fluid therapy improves tissue perfusion in our study, and further studies are needed to examine the effects of PVI and targeted fluid therapy on tissue perfusion in patients undergoing the same operation.

Keywords

• Peri-operative targeted fluid therapy
• PVI
• Bariatric surgery
• Lactate

Laparoskopik Sleeve Gastrektomi Uygulanan Hastalarda Pvi (Pleth Varıability Index) Kontrollü Hedefe Yönelik Sıvı Tedavisinin Organ Perfüzyonuna Etkisinin Araştırılması

Abstract

Bariatrik cerrahilerde intraoperatif sıvı yönetimi için açık bir kılavuz bulunmamaktadır. Hedefe yönelik sıvı tedavileri abdominal cerrahi geçiren hastaların prognozlarını iyileştirmektedir. Bu amaçla farklı yöntemler kullanılarak sıvı yönetim protokolleri uygulanmaktadır. Bu çalışmada laparoskopik sleeve gastrektomi geçiren hastalarda Pleth Variability Index (PVI) kullanılarak sıvı tedavisi uygulamasının perioperatif hemodinami ve doku perfüzyonuna etkisi araştırılmıştır. Bu çalışmaya laparaskopi sleeve gastrektomi geçirmiş 60 hasta dahil edilmiştir. Hastalar PVI kontrollü sıvı tedavisi (Grup I) ve standart sıvı tedavisi (Grup II) uygulananlar olarak ikiye ayrılmıştır. Grup I’e genel anestezi indüksiyonu sonrası 500 mL kristalloid bolus infüzyonu takiben 2 mL/kg/sa kristalloid uygulanmış, PVI > %14 durumunda 250 mL kolloid uygulanmıştır. Grup II’de indüksiyon sonrası 500 mL kristalloid bolus infüzyonu takiben 4-8 mL/kg/sa kristalloid uygulanmıştır. Ortalama arteriyel basınç < 65 mmHg durumunda norepinefrin uygulanmıştır. Perioperatif laktat düzeyleri ve hemodinamik veri kayıtları incelenmiştir. Grup I’de intraoperatif olarak uygulanan kristalloid hacmi belirgin derecede düşük bulunmuştur. Grup I’de intraoperatif 60. Dk ve postoperatif 48. Saatte ölçülen laktat düzeyleri anlamlı derecede düşük bulunmuştur. PVI kontrollü hedefe yönelik sıvı tedavileri intraoperatif dönemde uygulanan sıvı hacmini azaltıp, intraoperatif ve postoperatif laktat düzeylerini azaltmaktadır.

Keywords

• Peri-operatif hedefe yönelik sıvı tedavisi
• PVI
• Bariyatrik cerrahi
• Laktat

Ethical Statement

Bu çalışma 10.05.2016 tarih ve 144830 sayılı Fırat Üniversitesi Girişimsel Olmayan Araştırmalar Etik Kurulu Başkanlığı onayı ile Fırat Üniversitesi Hastanesinde 1 Mayıs 2015 – 31 Ağustos 2015 tarihleri arasında laparoskopik sleeve gastrektomi uygulanan hasta dosyaları retrospektif olarak incelendi.

References

1. Benes J, Giglio M, Brianza N, et al., (2014). The effects of goaldirected fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care. 18(5):584. DOI: 10.1186/s13054- 014-0584-z
2. Cannesson M, Attof Y, Rosamel P, et al., (2007). Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room. Anesthesiology, 106:1105–11. DOI: 10.1097/01.anes.0000267593.72744.20
3. Cannesson M, Delannoy B, Morand A, et al. (2008c) Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg., 106:1189–94. DOI: 10.1213/ane.0b013e318167ab1f
4. Cannesson M, Desebbe O, Rosamel P, et al., (2008b). Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth, 101:200–6. DOI: 10.1093/bja/aen133
5. Cannesson M, Slieker J, Desebbe O, et al., (2008a). The ability of a novel algorithm for automatic estimation of the respiratory variations in arterial pulse pressure to monitor fluid responsiveness in the operating room. Anesth Analg, 106:1195–200. DOI: 10.1213/01.ane.0000297291.01615.5c
6. Cavallaro F, Sandroni C, & Antonelli M., (2008) Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. Minerva Anestesiol, 74:123–35
7. Corcoran T, Rhodes JE, Carke S, et al. (2012). Perioperative fluid management strategies in major surgery: a stratified metaanalysis. Anesth Analg., 114(3):640–51. DOI: 10.1213/ane.0b013e318240d6eb
8. Dalfino L, Giglio MT, Puntillo F, et al. (2011). Haemodynamic goal directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis. Crit Care., 15(3):R154. DOI: 10.1186/cc10284

9. Demirel İ, Bolat E, Altun A, et al., (2018). Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients. Obes Surg., 28(2):358-363. DOI: 10.1007/s11695- 017-2840-1
10. Forget P, Lois F, & Kock M., (2010) Goal-Directed fluid management based on the pulse oximeter–derived pleth variability ındex reduces lactate levels and ımproves fluid management. Anesth Analg, 111: 910–914. DOI: 10.1213/ane.0b013e3181eb624f
11. Gómez-Izquierdo JC, Feldman LS, Carli F, et al., (2015) Metaanalysis of the effect of goal-directed therapy on bowel function after abdominal surgery. Br J Surg., 102:577–89. DOI: 10.1002/bjs.9747
12. Gustafsson UO, Hausel J, Thorell A, et al., (2011). Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg., 146:571–7. DOI: 10.1001/archsurg.2010.309
13. Hamilton MA, Cecconi M, & Rhodes A., (2011). A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg., 112(6):1392–402. DOI: 10.1213/ane.0b013e3181eeaae5
14. Michard F, & Teboul JL, (2002). Predicting fluid reponsiveness in ICU patients. A critical analysis of the evidence. Chest, 121(6):2000 – 8. DOI: 10.1378/chest.121.6.2000
15. Muñoz JL, Gabaldón T, Miranda E et al., (2016) Goal-directed fluid therapy on laparoscopic sleeve gastrectomy in morbidly obese patients. Obes Surg, 26: 2648–2653. DOI:10.1007/s11695-016-2145-9
16. Nguyen NT, Wolfe BM, (2005). The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg., 241:219–26. DOI: 10.1097%2F01.sla.0000151791.93571.70
17. Perel A, Minkovich L, Preisman S, et al. (2005) Assessing fluidresponsiveness by a standardized ventilatory maneuver: the respiratory systolic variation test. Anesth Analg., 100:942–5. DOI: 10.1213/01.ane.0000146939.66172.ae
18. Poeze M, Greve JWM, & Ramsay G., (2005) Meta-analysis of hemodynamic optimisation: relationship to methodological quality. Crit Care, 9:R771–9. DOI: 10.1186/cc3902
19. Shailaja S, Nichelle M. Kishan Shetty A, et al., (2014). Comparing ease of intubation in obese and lean patients using intubation difficulty scale. Journal List Anesth Essays Res, 8; 1-4. DOI: 10.4103%2F0259-1162.134493
20. Wool DB, Lemmens HJ, Brodsky JB, et al., (2010) Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients. Obes Surg., 20:698–701. DOI: 10.1007/s11695-010-0092-4
21. Wyffels PA, Durnez PJ, Helderweirt J, et al., (2007). Ventilationinduced plethysmographic variations predict fluid responsiveness in ventilated postoperative cardiac surgery patients. Anesth Analg. 105:448–52. DOI:10.1213/01.ane.0000267520.16003.17