Goal-directed fluid therapy in intracranial tumor resection guided by pressure recording analytical method
LIU Xiaomei1, DONG Lan2, CHEN Yu1, LV Hao1
1.Department of Anesthesiology,Navy General Hospital,Beijing 100048, China; 2.Department of Anesthesidogy,General Hospital of Chinese People’s Armed Police Force,Beijing 100039,China;
Abstract：Objective To evaluate the goal-directed fluid therapy guided by pressure recording analytical method (PRAM) in intracranial tumor resection.Methods Forty patients undergoing intracranial tumor resection were randomly divided into two groups: goal-directed fluid therapy group(Group G) and the traditional fluid therapy group(Group C). Group G received the goal-directed fluid therapy based on SVV, whereas group C was treated with a traditional fluid therapy based on CVP, MAP and the urinary output. The crystalloid requirements, colloid requirements, banked blood requirements, total fluid volume infused ,urinary output, bleeding volume,vasoactive drugs and hemodynamics during operation were recorded.Results The colloid volume, total fluid volume infused,and urinary output during operation were significantly larger in group G than in group C(P<0.05), so was MAP at T2-T4(P<0.05).Conclusions PRAM guided goal-directed fluid therapy can help optimize the capacity state in intracranial tumor resection patients and maintain the perioperative stability of hemodynamics .
Shoemaker W C, Appel P L, Kram H B, et al.Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients[J].Chest,1988,94(6):1176-1186.
[3]
Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery[J]. Anesth Analg,2001,92: 984-989.
Derichard A,Robin E,Tavernier B,et al.Automated pulse pressure and stroke volume variations from radial artery:evaluation during major abdominal surgery[J].Br J Anaesth,2009,103:678-684.
[6]
Miller T E,Roche A M,Gan T J.Poor adoption of hemodynamic optinmization during major surgery;are we practicing substandard care?[J].Anesth Analg,2011,112:1274-1276.
[7]
Reuter D A, Goresch T, Goepfert M S, et al. Effects of mid-line thoracotomy on the interaction between mechanical ventilation and cardiac filling during cardiac surgery[J]. Br J Anaesth, 2004,92: 808-813.
[8]
Marx G, Cope T, McCrossan L, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis[J]. Eur J Anaesth,2004,21:132-138.
[9]
Fujita Y, Yamamoto T, Sano I, et al.A comparison of changes in cardiac preload variables during graded hypovolemia and hypervolemia in mechanically ventilated[J].Dogs Anesth Analg,2004,99:1780-1786.
[10]
Marik P E,Baram M,Vahid B.Does central venous pressure predict fluid responsiveness? A syetematic review of the literature and the tale of seven mares[J].Chest,2008,134(1):172-178.
Kramer A, Zygun D, Hawes H, et al. Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery[J]. Chest,2004,126: 1563-1568.
[13]
Biais M, Bernard O, Ha J C, et al.Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery[J].Br J Anaesth,2010,104(4):407-413.
[14]
Bendjelid K, Romand J A.Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care[J]. Intensive Care Med, 2003,29: 352-360.
[15]
Marik P E,Baram M,Vahid B.Does central venous pressure predict fluid responsiveness? A syetematic review of the literature and the tale of seven mares[J].Chest,2008,134(1):172-178.
[16]
Benes J,Chytra I,Altmann P,et al.Intraoperative fluid optimization using stroke volume variation in high risk surgical patients:results of prospective randomized study[J].Crit Care,2010,14:R118.
[17]
Challand C,Struthers R,Sneyd J R,et al.Randomized controlled trail of intraoperative goal-directed fluid therapy in aerobically fit and unfit patient having major colorectal sugery[J].Br J Aneasth,2012,108(1):53-62.
[18]
Pomano S M,Pistolesi M.Assessment of cardiac output from systemic arterial pressure in humans[J].Crit Care Med,2002,30(8):1834-1841.
[19]
Giomarelli P, Biagioli B,Scolletta S.Cardiac output monitoring by pressure recording analytical method in cardiac surgery[J].Eur J Cardiothorac Surg,2004,26(3):515-520.
[20]
Romagnoli S,Ricci Z,Romano S M,et al.FloTrac/VigileoTM(Third Generation)and MostCare/PRAM versus echocardiography for cardiac output estimation in vascular surgery[J].J Cardiothorac Vasc Anesth,2013,27(6):1114-1121.
[21]
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[J]. Anesth Analg,2010,111:910-914.
2018, Vol. 29 
