Effect of different targets of goal-directed fluid therapy on intraoperative hypotension and fluid infusion in robot-assisted laparoscopic gynecological surgery: a randomized non-inferiority trial

作者全名："Chen, Qi; Wu, Bin; Deng, Meiling; Wei, Ke"

作者地址："[Chen, Qi; Wu, Bin; Deng, Meiling; Wei, Ke] First Affiliated Chongqing Med Univ, Dept Anesthesiol, Chongqing, Peoples R China; [Chen, Qi] Chongqing Univ, Dept Anesthesiol, Canc Hosp, Chongqing, Peoples R China"

通信作者："Wei, K (通讯作者)，First Affiliated Chongqing Med Univ, Dept Anesthesiol, Chongqing, Peoples R China."

来源：JOURNAL OF ROBOTIC SURGERY

ESI学科分类：　

WOS号：WOS:001185647700005

JCR分区：Q2

影响因子：2.2

年份：2024

卷号：18

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Carotid corrected flow time; Pulse pressure variation; Tidal volume challenge; Goal-directed fluid therapy; Hypotension; Robot-assisted

摘要："Carotid corrected flow time (FTc) and tidal volume challenge pulse pressure variation (VtPPV) are useful clinical parameters for assessing volume status and fluid responsiveness in robot-assisted surgery, but their usefulness as goal-directed fluid therapy (GDFT) targets is unclear. We investigated whether FTc or VtPPV as targets are inferior to PPV in GDFT. This single-center, prospective, randomized, non-inferiority study included 133 women undergoing robot-assisted laparoscopic gynecological surgery in the modified head-down lithotomy position. Patients were equally divided into three groups, and the GDFT protocol was guided by FTc, VtPPV, or PPV during surgery. Primary outcomes were non-inferiority of the time-weighted average of hypotension, intraoperative fluid volume, and urine output. Secondary outcomes were optic nerve sheath diameter (ONSD) pre- and post-operatively and creatinine and blood urea nitrogen preoperatively and on day 1 post-operatively. No significant differences were observed in intraoperative hypotension index, infusion and urine volumes, and ONSD post-operatively between the FTc and VtPPV groups and the PPV group. No differences in serum creatinine and urea nitrogen levels were identified between the FTc and VtPPV groups preoperatively, but on day 1 post-operatively, the urea nitrogen level in the FTc group was higher than that in the PPV group (4.09 +/- 1.28 vs. 3.0 +/- 1.1 mmol/L, 1.08 [0.59, 1.58], p < 0.0001), and the difference from the preoperative value was smaller than that in the PPV group (- 2 [- 2.97, 1.43] vs. - 1.34 [- 1.9, - 0.67], p = 0.004). FTc- or VtPPV-guided protocols are not inferior to that of PPV in GDFT during robot-assisted laparoscopic surgery in the modified head-down lithotomy position.Trial registration: Chinese Clinical Trial Registry (ChiCTR2200064419)."

基金机构：Chongqing Medical Scientific Research Project (joint project of the Chongqing Health Commission and Science and Technology Bureau)

基金资助正文：No Statement Available