Personalizezed Hemodynamic Optimization Using Stroke Volume, Pulse Pressure Variation, and Continuous Cardiac Index in Major Liver Surgery: A Randomized Controlled Trial.

Background/

Objectives

The aim of this study was to evaluate fluid administration and intraoperative bleeding of patients who had major hepatic resection. We used artery pulse contour analysis monitor (ProAQT™) and personalized hemodynamic target-guided therapy, in which the administration of fluid, inotropes and vasopressors is guided by stroke volume, pulse pressure variation (SVV, PPV) and continuous cardiac index (CI).

Methods

This trial was a prospective, randomized, parallel-group in adults scheduled for major hepatic resection. Participants were randomly assigned in equal numbers to one of two groups: (1) a control group receiving conventional perioperative care, and (2) an intervention group managed with goal-directed hemodynamic therapy guided by radial artery pulse contour analysis.

Results

45 patients were randomized to the GDHT (n = 16) and control group (n = 19). Blood loss was significantly higher in the control group than in GDHT group (728.13 ± 618.59 versus 292.63 ± 274.06, p = 0.009). The number of patients receiving intraoperative transfusion was significantly higher in the first group (6 ± 16 versus 0 ± 19, p = 0.005). Total volume infused was significantly higher in control group (CG) than in GDHT group (GG) (2853.13 ± 1432.18 versus 1125.79 ± 751.2, p = 0.001).

Conclusions

Personalized goal-directed therapy optimizes intraoperative fluid administration during major liver resection and reduces blood transfusion.