A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery

Abstract\ud \ud Background\ud Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study.\ud \ud \ud Methods\ud The patients were included in two periods: a first control period (control group; n = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group). We performed 1:1 propensity score matching to ensure the groups were comparable with regard to age, weight, duration of surgery, and type of operation. The primary endpoint was postoperative hospital length of stay.\ud \ud \ud Results\ud After matching, 84 patients remained in each group. Baseline characteristics, surgical procedure duration and physiological parameters evaluated at the start of surgery were similar between the groups. The volume of crystalloids (4500 mL [3200-6500 mL] versus 5000 mL [3750-8862 mL]; P = 0.01), the number of blood units infused during the surgery (1.7 U [0.9-2.0 U] versus 2.0 U [1.7-2.6 U]; P = 0.01), the fraction of patients transfused (13.1% versus 32.1%; P = 0.003) and the number of patients receiving mechanical ventilation at 24 h (3.2% versus 9.7%; P = 0.027) were smaller postoperatively in PPV group. Intraoperative PPV-based improved the composite outcome of postoperative complications OR 0.59 [95% CI 0.35-0.99] and reduced the postoperative hospital length of stay (8 days [6-14 days] versus 11 days [7-18 days]; P = 0.01).\ud \ud \ud Conclusions\ud In high-risk surgeries, PPV-directed volume loading improved postoperative outcomes and decreased the postoperative hospital length of stay.\ud \ud \ud Trial Registration\ud ClinicalTrials.gov Identifier; retrospectively registered- \ud NCT03128190The authors declare that this study was supported by DIXTAL BIOMÉDICA INDÚSTRIA E COMÉRCIO LTDA. DIXTAL BIOMÉDICA INDÚSTRIA E COMÉRCIO LTDA donated the study devices. However, Dixtal organization did not have any influence on (1) the design and conduct of the study; (2) the collection, management, analysis and interpretation of the data; (3) the preparation, review or approval of the manuscript; (4) the decision to submit the manuscript for publication