AUTHOR=Tang Wei , Qiu Yuwei , Lu Huijie , Xu Meiying , Wu Jingxiang 

TITLE=Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial

JOURNAL=Frontiers in Surgery

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.794272

DOI=10.3389/fsurg.2021.794272

ISSN=2296-875X

ABSTRACT=<p><bold>Study Objective:</bold> This study aimed to investigate whether stroke volume variation (SVV)-guided goal-directed therapy (GDT) can improve postoperative outcomes in elderly patients undergoing minimally invasive esophagectomy (MIE) compared with conventional care.</p><p><bold>Design:</bold> A prospective, randomized, controlled study.</p><p><bold>Setting:</bold> A single tertiary care center with a study period from November 2017 to December 2018.</p><p><bold>Patients:</bold> Patients over 65 years old who were scheduled for elective MIE.</p><p><bold>Interventions:</bold> The GDT protocol included a baseline fluid supplement of 7 ml/kg/h Ringer's lactate solution and SVV optimization using colloid boluses assessed by pulse-contour analysis (PiCCO™). When SVV exceeded 11%, colloid was infused at a rate of 50 ml per minute; if SVV returned below 9% for at least 2 minutes, then colloid was stopped.</p><p><bold>Measurements:</bold> The primary outcome was the incidence of postoperative complications before discharge, as assessed using a predefined list, including postoperative anastomotic leakage, postoperative hoarseness, postoperative pulmonary complications, chylothorax, myocardial injury, and all-cause mortality.</p><p><bold>Main Results:</bold> Sixty-five patients were included in the analysis. The incidence of postoperative complications between groups was similar (GDT 36.4% vs. control 37.5%, <italic>P</italic> = 0.92). The total fluid volume was not significantly different between the two groups (2,192 ± 469 vs. 2,201 ± 337 ml, <italic>P</italic> = 0.92). Compared with those in the control group (<italic>n</italic> = 32), patients in the GDT group (<italic>n</italic> = 33) received more colloids intraoperatively (874 ± 369 vs. 270 ± 67 ml, <italic>P</italic> &lt;0.05) and less crystalloid fluid (1,318 ± 386 vs. 1,937 ± 334 ml, <italic>P</italic> &lt;0.05).</p><p><bold>Conclusion:</bold> The colloid-based SVV optimization during GDT did not significantly reduce the incidence of early postoperative complications after minimally invasive esophagectomy in elderly patients.</p><p><bold>Clinical Trial Number and Registry URL:</bold> ChiCTR-INR-17013352; <ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn/showproj.aspx?proj=22883" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.chictr.org.cn/showproj.aspx?proj=22883</ext-link></p>