Effects of volumetric vs. pressure-guided fluid therapy on postoperative inflammatory response: A prospective, randomized clinical trial

Tamas Szakmany, Ildiko Toth, Zsolt Kovacs, Tamas Leiner, Andras Mikor, T. Kőszegi, Z. Molnár

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: To compare intrathoracic blood volume (ITBV) guided fluid management and central venous pressure (CVP) guided therapy in ameliorating the progression of early systemic inflammatory response in patients undergoing major surgery. Design: Prospective, randomized clinical trial. Patients: Forty patients undergoing major abdominal surgery were randomized into CVP and ITBV groups. Interventions: In the CVP group the target CVP was 8-12 mmHg while in the ITBV group the goal was to keep the ITBV between 850 and 950 ml/m 2 during the operation. Measurements and results: Hemodynamic parameters were determined by single arterial thermodilution. Measurements were repeated every 30 min intraoperatively. Serum procalcitonin (PCT) and C-reactive protein (CRP) was monitored preoperatively, on ICU admission, and then daily for 3 days. Serum TNF-α levels were measured intraoperatively hourly and then daily for 3 days. There was no significant difference between the two groups regarding hemodynamic parameters at any assessment point. In the overall population changes in the stroke volume index showed a significant correlation with changes in CVP and ITBV. TNF-α levels remained in the normal range intraoperatively and during the three postoperative days in both groups. Preoperatively normal PCT and CRP levels increased significantly postoperatively, without significant differences between the groups. Conclusions: ITBV guided fluid therapy did not alter the magnitude of inflammatory response as monitored by serum PCT, CRP, and TNF-α in the early postoperative period.

Original languageEnglish
Pages (from-to)656-663
Number of pages8
JournalIntensive Care Medicine
Volume31
Issue number5
DOIs
Publication statusPublished - May 2005

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Fluid Therapy
Blood Volume
Central Venous Pressure
Randomized Controlled Trials
Pressure
Calcitonin
C-Reactive Protein
Blood Group Antigens
Hemodynamics
Serum
Thermodilution
Postoperative Period
Stroke Volume
Reference Values
Population

Keywords

  • C-reactive protein
  • Central venous pressure
  • Intrathoracic blood volume index
  • Procalcitonin
  • Systemic inflammatory response
  • Tumor necrosis factor α

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Effects of volumetric vs. pressure-guided fluid therapy on postoperative inflammatory response : A prospective, randomized clinical trial. / Szakmany, Tamas; Toth, Ildiko; Kovacs, Zsolt; Leiner, Tamas; Mikor, Andras; Kőszegi, T.; Molnár, Z.

In: Intensive Care Medicine, Vol. 31, No. 5, 05.2005, p. 656-663.

Research output: Contribution to journalArticle

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