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Br J Anaesth. 2017 Nov 1;119(5):934-942. doi: 10.1093/bja/aex189.

Comparison of two stroke volume variation-based goal-directed fluid therapies for supratentorial brain tumour resection: a randomized controlled trial.

Author information

1
Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei City 100, Taiwan.
2
Department of Life Science, National Taiwan Normal University, Taipei City, Taiwan.
3
Department of Neurosurgery, National Taiwan University Hospital, Taipei City, Taiwan.

Abstract

Background:

The optimal volume status for neurosurgery has yet to be determined. We compared two fluid protocols based on different stroke volume variation (SVV) cut-offs for goal-directed fluid therapy (GDFT) during supratentorial brain tumour resection.

Methods:

A randomized, single-blind, open-label trial was conducted. Eighty adult patients undergoing elective supratentorial brain tumour resection were randomly divided into a low SVV and a high SVV group. The SVV cut-offs were used to determine when to initiate colloid infusion. Clinical outcomes and perioperative changes in serum neuronal biomarkers, including S100β, neurone-specific enolase (NSE) and glial fibrillary acidic protein (GFAP), were compared.

Results:

Patients in the low SVV group received a higher volume of colloid [869 (SD 404) vs 569 (453) ml; P=0.0025], had a higher urine output [3.4 (2.4) vs 2.5 (1.7) ml kg-1 h-1; P=0.0416] and a higher average cardiac index [3.2 (0.7) vs 2.8 (0.6) litres min-1 m-2; P=0.0204]. Patients in the low SVV group also had a shorter intensive care unit stay [1.4 (0.7) vs 2.6 (3.3) days, P=0.0326], fewer postoperative neurological events (17.5 vs 40%, P=0.0469), attenuated changes in the NSE and GFAP levels, lower intraoperative serum lactate and a higher Barthel index at discharge (all P<0.05).

Conclusions:

During GDFT for supratentorial brain tumour resection, fluid boluses targeting a lower SVV are more beneficial than a restrictive protocol.

Clinical trial registration:

NCT02113358.

KEYWORDS:

brain tumour; goal-directed fluid therapy; stroke volume variation

PMID:
28981592
DOI:
10.1093/bja/aex189
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