Impact Of The Flotrac/Vigileo (Tm) Monitoring On Intraoperative Fluid Management And Outcome After Liver Resection

Backgrounds: Perioperative fluid-therapy is a still a debated issue. In hepatic surgery, volume load must be strictly monitored to assure both a safe hemodynamics and low central venous pressure (CVP) to limit the backflow bleeding. Retrospectively, we compared intraoperative fluid management before and after the adoption of a semi-invasive hemodynamic monitoring. Methods: We compared patients submit-ted to liver resection monitored by FloTrac/Vigileo (TM) (group A) vs. patients who did not (group B). We searched for differences about hemodynamics, fluid therapy and outcome. Results: Three hundred fifty-five patients underwent hepatic resection due to neoplasm: group A - n = 179 and group B -n = 176. At the end of the resection, patients of group A showed a higher mean arterial pressure (MAP) than group B (74 +/- 12 vs. 49.4 +/- 8 mm Hg, respectively; p < 0.001). Cardiac index and stroke volume variation in group A were within a normal range. Fluid input was higher in group B than in group A (12.0 +/- 3.4 vs. 7.6 +/- 3.1 mL/kg/h, respectively; p < 0.001) and fluid balance was significantly different: group A -400 +/- 1,527 vs. group B 326 +/- 1,527 mL (p < 0.001). Group B showed a greater number of cases complicated outcomes (36 vs. 20; p = 0.014). Considering only those subjects who were able to reach their hemodynamic targets (MAP >= 65 mm Hg and CVP <= 7 mm Hg), we found similar data. Conclusions: Patients who received a monitored fluid therapy experienced a safer outcome. (C) 2017 S. Karger AG, Basel