Effectiveness of goal-directed fluid therapy guided by estimated continuous cardiac output (esCCO) in major gastrointestinal surgeries: a randomized controlled trial

Abstract

Background & Objective: This study was conducted to compare the effectiveness between goal-directed fluid therapy guided by Estimated Continuous Cardiac Output (esCCO) monitoring and liberal infusion therapy on the early perioperative and postoperative complications, as well as long-term complications in major gastrointestinal surgeries. Methodology: A randomized controlled trial was conducted at Hanoi Medical University Hospital, Hanoi, Vietnam from October 2020 to October 2021. There were 138 patients enrolled in the study and divided randomly into two groups: Group LIF (liberal infusion therapy) and Group GD (goal-directed fluid therapy using esCCO monitors). The logistic regression (univariate and multivariate) analysis models were performed to evaluate the relationship between the complication (yes or no) and potential predictors. Results: Mortality and length of hospital stay in the esCCO group were not different from those in the liberal infusion therapy group (P > 0.05). Postoperative respiratory complications such as pneumonia and pulmonary edema were lower in the Group GD but not statistically significant compared with the Group LIF (5.7% vs 7.4% with P > 0.05). There was a higher rate of acute kidney injury in the Group GD than in the Group LIF, but the difference was not statistically significant (5.7% vs 1.5% with P > 0.05). Other complications such as bleeding, wound infection, and tissue edema in the Group GD was almost equivalent to those in the Group LIF and the difference was not statistically significant. Conclusion: Goal-directed fluid therapy according to esCCO guidelines reduced the amount of intraoperative fluids while maintaining hemodynamic stability during surgery, but has not shown a real effect in reducing postoperative complications. Further studies with a larger number of patients are needed, in high-risk groups of patients requiring intravenous fluids according to esCCO guidelines to better evaluate the effectiveness of reducing postoperative complications. Abbreviations: esCCO - Estimated Continuous Cardiac Output; esSVI - Estimated Stroke Volume Index; PEEP -Positive End-Expiratory Pressure; MAC - Minimum Alveolar Concentration Key words: esCCO; Gastrointestinal Surgeries; Goal-directed Fluid Therapy; Infusion Therapy; Randomized Controlled Trial Citation: Hoang Vu P, Anh Duong ND, Viet Duc Tran VD, Tran TH, Luu VX, Truong QT, Nguyen HT, Ochiai R. Effectiveness of goal-directed fluid therapy guided by estimated continuous cardiac output (esCCO) in major gastrointestinal surgeries: a randomized controlled trial. Anaesth. pain intensive care 2023;27(3):371−378; DOI: 10.35975/apic.v27i3.2242 Received: November 15, 2022; Reviewed: April 29, 2023; Accepted: April 29, 2023