Goal Directed Fluid Management During High Risk Surgery, Dr. Perz

Katie Perz, D.O.

Goal Directed Fluid Management Based on Pulse Pressure Variation Monitoring During High Risk Surgery: A Pilot Randomized Controlled Trial

Lopes, M., Oliveira, M., Pereira, V., Lemos, I., Auler, J., Michard, F.  J Crit Care, v.11 (5); 2007.

Several studies have shown that maximizing stroke volume by volume loading during high-risk surgery may improve post operative outcome.  The goal of this study was to determine whether this goal could be achieved by simply by minimizing the variation in arterial pulse pressure induced by mechanical ventilation.  In this study, thirty three patients undergoing high-risk surgery were randomized; the intervention group was continuously monitored during surgery by a multiparameter bedside monitor and minimized to 10% or less by volume loading.  The study was done in Brazil, and the “multiparameter bedside monitor” was made by a company called Dixtal, and the monitor was referred to as the DX2020.  The arterial pressure curve was recorded via a specific module (IBPplus; Dixtal), allowing calculation of the change in pulse pressure.  The study concluded that monitoring and minimizing the change in pulse pressure by fluid loading during high-risk surgery decreases the incidence of post operative complications and also the duration of mechanical ventilation, stay in the ICU, and stay in the hospital.