<abstract xmlns="http://www.w3.org/1999/xhtml">

Fluid management in the perioperative period is a grey zone in clinical practice of late. Looking back on previous practices, static parameters were the only options. Now, dynamic parameters indicating fluid responsiveness have become a significant part of goal-directed fluid therapy (GDFT). However, the efficacy of this approach has yet to be established in neurosurgery cases where patients are already on lot of diuretics, thus making fluid management more challenging. The present study aims to determine the efficacy of the Pleth Variability Index (PVI) with pulse pressure variation (PPV) in guiding GDFT in patients undergoing neurosurgery for supra-tentorial intracranial space occupying lesions (ICSOLs), in the form of a randomised controlled trial.
After randomisation, the patients were categorised into either PVI or PPV groups. Both received a baseline 2 ml/kg/h Lactated Ringer’s (RL) infusion. Additional fluid boluses consisted of 250 ml of colloid infused over a 10 min period if PVI was > 15% or PPV was > 13% for at least five minutes. The primary outcome was to determine the serum lactate difference between preoperative and postoperative values, which could fairly predict fluid deficit leading to inadequate perfusion.
A total of 74 patients were analysed. Both PVI- and PPV-guided GDFT strategies showed no significant difference in the postoperative lactate values, with a P-value of 0.18. Similarly, the mean total fluid administered, mean blood loss, length of CCU stay, and emetic and hypotension episodes also showed no significant differences among the groups with P-values of 0.41, 0.78, 0.25, 0.30, and 0.67, respectively.
For patients undergoing neurosurgery (supratentorial ICSOLs), PVI seems to guide GDFT comparably to PPV regarding tissue perfusion and postoperative complications. However, both the parameters had low sensitivity and specificity, with an area of curve of 0.577 for PPV and 0.423 for PVI, as far as GDFT was concerned.
</abstract>

Fluid management in the perioperative period is a grey zone in clinical practice of late. Looking back on previous practices, static parameters were the only options. Now, dynamic parameters indicating fluid responsiveness have become a significant part of goal-directed fluid therapy (GDFT). However, the efficacy of this approach has yet to be established in neurosurgery cases where patients are already on lot of diuretics, thus making fluid management more challenging. The present study aims to determine the efficacy of the Pleth Variability Index (PVI) with pulse pressure variation (PPV) in guiding GDFT in patients undergoing neurosurgery for supra-tentorial intracranial space occupying lesions (ICSOLs), in the form of a randomised controlled trial.
After randomisation, the patients were categorised into either PVI or PPV groups. Both received a baseline 2 ml/kg/h Lactated Ringer’s (RL) infusion. Additional fluid boluses consisted of 250 ml of colloid infused over a 10 min period if PVI was > 15% or PPV was > 13% for at least five minutes. The primary outcome was to determine the serum lactate difference between preoperative and postoperative values, which could fairly predict fluid deficit leading to inadequate perfusion.
A total of 74 patients were analysed. Both PVI- and PPV-guided GDFT strategies showed no significant difference in the postoperative lactate values, with a P-value of 0.18. Similarly, the mean total fluid administered, mean blood loss, length of CCU stay, and emetic and hypotension episodes also showed no significant differences among the groups with P-values of 0.41, 0.78, 0.25, 0.30, and 0.67, respectively.
For patients undergoing neurosurgery (supratentorial ICSOLs), PVI seems to guide GDFT comparably to PPV regarding tissue perfusion and postoperative complications. However, both the parameters had low sensitivity and specificity, with an area of curve of 0.577 for PPV and 0.423 for PVI, as far as GDFT was concerned.

A Randomised Controlled Study Comparing Pulse Pressure Variation (PPV) and Pleth Variability Index (PVI) for Goal-Directed Fluid Therapy Intraoperatively in Patients Undergoing Intracranial (Supratentorial ICSOLs) Surgeries

Romanian Journal of Anaesthesia and Intensive Care

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fluid management in the perioperative period is a grey zone in clinical practice of late. Looking back on previous practices, static parameters were the only...

Area	Std. Error^a	Asymptotic Sig.^b	Asymptotic 95% Confidence Interval
Area	Std. Error^a	Asymptotic Sig.^b	Lower Bound	Upper Bound
0.577	0.067	0.254	0.446	0.708

Area	Std. Error^a	Asymptotic Sig.^b	Asymptotic 95% Confidence Interval
Area	Std. Error^a	Asymptotic Sig.^b	Lower Bound	Upper Bound
0.423	0.067	0.254	0.292	0.554

PARAMETERS	PPV (MEAN)	PVI (MEAN)	P-VALUE
BMI	22.06 KG/M2	22.69 KG/M2	0.29
PRE-INDUCTION LACTATE	1.47	1.32	0.21
POST SURGERY LACTATE	2.72	2.50	0.18
PRE-OP Hb	12.14 GM/DL	12.17 GM/DL	0.93
MABL	1194.19 ML	1224.7 GM/DL	0.81
MEAN FLUID ADMINISTERED	1362.16 ML	1443.24 ML	0.41
MEAN BLOOD LOSS	645.95 ML	628.38 ML	0.63
MEAN BLOOD TRANSFUSED	465.33 ML	482.86 ML	0.78
MEAN URINE OUTPUT	359.31 ML	321.46 ML	0.79
NO OF HYPOTENSION EPISODES	37	37	0.67
MAX STAY IN CCU	1 DAY	2 DAYS	0.25
MAX EMETIC EPISODES	1	1	0.30

A Randomised Controlled Study Comparing Pulse Pressure Variation (PPV) and Pleth Variability Index (PVI) for Goal-Directed Fluid Therapy Intraoperatively in Patients Undergoing Intracranial (Supratentorial ICSOLs) Surgeries

Article Category: Original Paper

Published Online: Apr 20, 2023

Page range: 18 - 25

DOI: https://doi.org/10.2478/rjaic-2023-0003

Keywords
fluid management, goal-directed fluid therapy, pulse pressure variation, Pleth Variability Index, supratentorial tumours

© 2023 Pratyasa Nayak et al., published by sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1.

Figure 2.

Test Result Variable(s): POST SURG LACTATE

Test Result Variable(s): Post-surgical Lactate

Parameters compared in PPV and PVI groups

A Randomised Controlled Study Comparing Pulse Pressure Variation (PPV) and Pleth Variability Index (PVI) for Goal-Directed Fluid Therapy Intraoperatively in Patients Undergoing Intracranial (Supratentorial ICSOLs) Surgeries

Article Category: Original Paper

Published Online: Apr 20, 2023

Page range: 18 - 25

DOI: https://doi.org/10.2478/rjaic-2023-0003

Keywordsfluid management, goal-directed fluid therapy, pulse pressure variation, Pleth Variability Index, supratentorial tumours

© 2023 Pratyasa Nayak et al., published by sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1.

Figure 2.

Test Result Variable(s): POST SURG LACTATE

Test Result Variable(s): Post-surgical Lactate

Parameters compared in PPV and PVI groups

Keywords
fluid management, goal-directed fluid therapy, pulse pressure variation, Pleth Variability Index, supratentorial tumours