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Perioperative volume management for esophageal cancer surgery

Introduction

Pulmonary complications are the primary reason for extending a patient's stay in the ICU. The aim of this study was to investigate whether perioperative volume management can influence the PaO2/FiO2 value and total length of stay in the ICU.

Methods

Sixteen patients were divided into two groups: one group was treated with a restrictive approach (≤8 ml/kg/hour), and the other with a liberal approach (> 8 ml/kg/hour). Patients were randomly allocated using sealed envelopes. During the thoracic part of the surgical procedure, all patients received one-lung ventilation (OLV).

Results

In the group treated with a restrictive volume approach, patients received fluids at the rate of 7.0 ± 1.0 ml/kg/hour. PaO2/FiO2 was 288 ± 14 after intubation and 270 ± 22 before extubation. In the group treated with a liberal volume approach, fluids were replaced at 11.0 ± 2.0 ml/kg/hour. PaO2/FiO2 was 259 ± 24 after intubation and 223 ± 43 before extubation. Surgery combined with OLV was found to significantly affect the PaO2/FiO2 value (ANOVA, F 1,14 = 15.85a, P = 0.001, partial η2 = 0.531). The average PaO2/FiO2 level was significantly higher in the restrictive-replacement group than in the liberal-replacement group (ANOVA, F 1,14 = 9.66, P = 0.008, partial η2 = 0.408). There was no interaction between the groups (ANOVA, F 1,14 = 1.7a, P = 0.215, partial η2 = 0.108). Mean length of stay in the ICU was similar between the restrictive-replacement group (5.2 ± 2.3 days) and the liberalreplacement group (6.3 ± 1.6 days) (ANOVA, F 1,14 = 0.814a, P = 0.382, partial η2 = 0.055).

Conclusion

Results from this small sample indicate that esophageal carcinoma surgery by itself had a detrimental effect on the PaO2/FiO2 value, which restriction of perioperative volume did not significantly affect. Volume restriction also did not affect length of stay in the ICU.

References

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Correspondence to M Karaman Ilic.

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Ilic, M.K., Madžarac, G., Kogler, J. et al. Perioperative volume management for esophageal cancer surgery. Crit Care 17, P194 (2013). https://doi.org/10.1186/cc12132

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Keywords

  • Esophageal Cancer
  • Esophageal Carcinoma
  • Pulmonary Complication
  • Volume Restriction
  • Seal Envelope