Impact of the fluid challenge infusion rate on cardiac stroke volume during major spinal neurosurgery: a prospective single center randomized interventional trial

[摘要] BackgroundFluid therapy, including the choice of a crystalloid or colloid infusion, the execution time of a volume bolus, and the expected volume need of a patient during surgery, varies greatly in clinical practice. Different goal directed fluid protocols have been developed, where fluid boluses guided by dynamic preload parameters are administered within a specific period.ObjectiveTo study the efficacy of two fluid bolus infusion rates measured by the response of hemodynamic parameters.DesignMonocentric randomized controlled interventional trial.SettingUniversity hospital.PatientsForty patients undergoing elective major spinal neurosurgery in prone position were enrolled, thirty-one were finally analyzed.InterventionsPatients were randomly assigned to receive 250 ml crystalloid and colloid boluses within 5 min (group 1) or 20 min (group 2) when pulse pressure variation (PPV) exceeded 14%.Main outcome measuresChanges in stroke volume (SV), mean arterial pressure (MAP), and catecholamine administration.ResultsGroup 1 showed a greater increase in SV (P = 0.031), and MAP (P = 0.014), while group 2 still had higher PPV (P = 0.005), and more often required higher dosages of noradrenalin after fluid administration (P = 0.033). In group 1, fluid boluses improved CI (P < 0.01), SV (P < 0.01), and MAP (P < 0.01), irrespective of whether crystalloids or colloids were used. In group 2, CI and SV did not change, while MAP was slightly increased (P = 0.011) only after colloid infusion.ConclusionsA fluid bolus within 5 min is more effective than those administered within 20 min and should therefore be the primary treatment option. Furthermore, bolus infusions administered within 20 min may result in volume overload without achieving relevant hemodynamic improvements.Trial registrationGerman Clinical Trials Register: DRKS00022917.

[发布日期] 2022-12-16

[关键词] Spinal surgery;Fluid therapy;Crystalloid;Colloid;Goal directed therapy