The Effect of Intra-Operative Plethysmography Variability Index-guided Fluid Therapy on Serum Lactate Levels: A Randomized Double-blinded Clinical Trial
Background: Goal-directed fluid therapy may improve perioperative fluid management. This study aimed to evaluate the effects of Pleth variability index (PVI)-guided fluid therapy on changes in intraoperative serum lactate levels in comparison with liberal fluid therapy.
Methods: This study was a randomized double-blinded clinical trial that was conducted in the operating room of a university hospital. Inclusion criteria comprised patients aged 18–60 years and classified as American Society of Anesthesiologists physical status class I and II, who were candidates for elective thyroidectomy. In total, 44 patients meeting the inclusion criteria were enrolled in the study and randomly assigned to two groups: the liberal and PVI groups. In both groups, 5 mL/kg bolus of normal saline was infused prior to the anesthesia induction. In the PVI group, 100 mL bolus of normal saline was administered every 5 min if the PVI remained >13% during the operation. In the liberal group, continuous crystalloid infusion (5–6 mL/kg/h) was administered throughout the surgery. Arterial blood samples were taken, and serum lactate levels were measured following anesthesia induction and just before tracheal extubation.
Results: In the PVI group, mean serum lactate decreased at the end of the surgery, with a difference of −0.6 ± 0.13 mmol/L, whereas it increased in the liberal group (0.070 ± 0.3, P<0.05).
Conclusion: In conclusion, we found that using intraoperative PVI-guided fluid therapy could decrease serum lactate levels and total fluid administration compared to the liberal method.
 Kudnig ST, Mama K. Perioperative fluid therapy. J Am Vet Med Assoc. 2002; 221(8):1112-21.
 Sulzer JK, Sastry AV, Meyer LM, Cochran A, Buhrman WC, Baker EH, et al. The impact of intraoperative goal-directed fluid therapy on complications after pancreaticoduodenectomy. Ann Med Surg (Lond). 2018; 36:23-8.
 Weinberg L, Wong D, Karalapillai D, Pearce B, Tan CO, Tay S, et al. The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple’s procedure). BMC anesthesiol. 2014; 14(1):35.
 Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Critical care medicine. 2013; 41(7):1774-81.
 Rollins KE, Lobo DN. Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials. Anna surg. 2016; 263(3):465-76.
 Waldron NH, Miller TE, Gan TJ. Perioperative goal-directed therapy. J Cardiothorac Vasc Anesth. 2014; 28(6):1635-41.
 Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, et al. 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. 2008; 101(2):200-6.
 Cannesson M, Delannoy B, Morand A, Rosamel P, Attof Y, Bastien O, et al. Does the pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg. 2008;106(4):1189-94.
 Munoz R, Laussen PC, Palacio G, Zienko L, Piercey G, Wessel DL. Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: an early indicator of morbidity and mortality. J Thorac Cardiovasc Surg. 2000; 119(1):155-62.
 Kanazawa T, Egi M, Shimizu K, Toda Y, Iwasaki T, Morimatsu H. Intraoperative change of lactate level is associated with postoperative outcomes in pediatric cardiac surgery patients: retrospective observational study. BMC Anesthesiol. 2015; 15(1):29.
 Thacker JK, Mountford WK, Ernst FR, Krukas MR, Mythen MMG. Perioperative fluid utilization variability and association with outcomes. Ann surg. 2016; 263(3):502-10.
 Forget P, Lois F, De Kock M. Goal-directed fluid management based on the pulse oximeter–derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg. 2010;111(4):910-4.
 Yu Y, Dong J, Xu Z, Shen H, Zheng J. Pleth variability index-directed fluid management in abdominal surgery under combined general and epidural anesthesia. J Clin Monit Comput. 2015; 29(1):47-52.
 Bahlmann H, Hahn R, Nilsson L. Agreement between Pleth Variability Index and oesophageal Doppler to predict fluid responsiveness. Acta Anaesthesiol Scand. 2016; 60(2):183-92.
 Dhar M, Datta R, Gupta N, editors. Correlation Between Plethysmographic Variability Index and Systolic Pressure Variation as an Indicator for Fluid Responsiveness in Hypotensive Patients on Ventilator in The Intensive Care Unit of a Tertiary Care Hospital. Anesthesia and Analgesia; 2016: Lippincott Williams & Wilkins Two Commerce Sq, 2001 Market St, Philadelphia ….
 Investigators A, Group tACT. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014; 371(16):1496-506.
 Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-11.
 Philippi L, Closhen D, Fukui K, Schmidtmann I, Ikeda M, Pestel G. Non-invasive assessment of functional haemodynamic parameters: 3AP4-4. Eur J Anaesthesiol. 2011; 28:36.
 Monnet X, Guerin L, Jozwiak M, Bataille A, Julien F, Richard C, et al. Pleth variability index is a weak predictor of fluid responsiveness in patients receiving norepinephrine. Br J Anaesth. 2012; 110(2):207-13.
 Joshi GP, Kehlet H. CON: perioperative goal-directed fluid therapy is an essential element of an enhanced recovery protocol? Anesth Analg. 2016; 122(5):1261-3.
 Bartha E, Davidson T, Hommel A, Thorngren K-G, Carlsson P, Kalman S. Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture PatientsBeforeClinical Research Starts. Anesthesiology. Anesthesiology. 2012; 117(3):519-30.
 Ebm C, Cecconi M, Sutton L, Rhodes A. A cost-effectiveness analysis of postoperative goal-directed therapy for high-risk surgical patients. Crit Care Med. 2014; 42(5):1194-203.
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