Effect of Plethysmography Variability Index Based Fluid Therapy in Enhancing Recovery Aftermajor Abdominal-pelvicsurgery

Abstract

STUDY BACKGROUND: Intra-operative fluid management based on Heart Rate (HR), Mean arterial pressure (MAP), Central Venous Pressure (CVP), urine output (U/O), replacing perioperative fluid deficits, insensible losses and ongoing fluid losses defines today’s approach to perioperative fluid paradigm. However, these parameters may be insensitive indicators of hypovolemia or changes in cardiac index (CI). Plethysmography variability index (PVI has been shown to have the ability to predict if patients will respond to additional fluids non-invasively under mechanical ventilation and has also been shown to improve patient outcomes however we don’t have local data. Main Objective: To compare the effectiveness of PVI Guided Fluid Therapy (GDT) with the conventional fluid therapy in terms of intra-operative fluid management, incidence of Post-Operative Nausea and Vomiting (PONV), time to start oral feeds and incidence of post-operative complications. Methods: The study was a quasi-experimental post-test only non-equivalent group design. 90 American Society of Anesthesiologists physical status classification (ASA)1 and 2 patients, more than 18years, with no cardiopulmonary disease undergoing major abdominal-pelvic surgery were recruited and assigned to either conventional or PVI group. The study was carried out in Kenyatta National Hospital (KNH) main theaters, Main theatre Post-anesthesia care unit (PACU) and the general wards post-operatively. In the conventional group fluids were administered based on HR, MAP, CVP, U/O. The PVI group, fluid was administered guided by the PVI measurements maintaining PVI> 10 and MAP> 65mmhg. Results; There was no difference in the amount of intraoperative crystalloid fluid and total fluids infused between the PVI and conventional group (P=0.26 P=0.7). No significant nausea and vomiting in both the PVI and conventional groups. There was no difference in oral intake between the two xvi

groups with a P value of 0.99. None of the patients developed postoperative complications during the follow up period of the study. Conclusion There was no difference in the amount of crystalloids and total fluids given between the conventional and total fluids infused. There was low incidence of PONV in both groups and postoperative complications were not observed during the study period.