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Perioperative volume management for esophageal cancer surgery
Critical Care volume 17, Article number: P194 (2013)
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
Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I: Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005, 103: 25-32. 10.1097/00000542-200507000-00008
Wei S, Tian J, Song X, Chen Y: Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg 2008, 86: 266-272. 10.1016/j.athoracsur.2008.03.017
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Ilic, M.K., Madžarac, G., Kogler, J. et al. Perioperative volume management for esophageal cancer surgery. Crit Care 17 (Suppl 2), P194 (2013). https://doi.org/10.1186/cc12132
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DOI: https://doi.org/10.1186/cc12132