Does the pleth variability index improve fluid management during major abdominal surgery?

Introduction

Dynamic parameters predict fluid responsiveness and improve fluid management during surgery. We intend to demonstrate that the noninvasive pleth variability index (PVI) guides peroperative fluid management and optimizes the circulatory status.

Methods

Patients scheduled for major abdominal surgery were randomized into two groups comparing the peroperative PVI-directed fluid management (group P) versus standard care (control, group C). Protocol: induction of general anesthesia was followed by, in group P, 500 ml followed by 2 ml/kg/hour crystalloids; 250 ml colloids infused if PVI >13% for more than 5 minutes; if required, vasoactive support was introduced after lowering PVI <10%. In group C, 500 ml crystalloids followed by fluids at the discretion of the anesthesiologist.

Results

Eighty-two patients completed the protocol. No difference was detected in preoperative characteristics, type of surgery and anesthesia. Peroperative and postoperative (24-hour) crystalloid infusions were significantly different. Lactate levels were significantly lower in group P, whereas the peroperative and postoperative volumes infused in group P were lower (Figure 1).

Figure 1

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Conclusion

Tzhe PVI improves peroperative fluid management in abdominal surgery. The reduced mean volume infused associated with reduced lactate levels suggests the capacity of the PVI to infer tailored fluid administration.