Goal Directed Fluid Therapy During Pancreatico-Duodenectomy Operation Stroke Volume Variation Compared to Central Venous Pressure

Background: Aim was to investigate the Electrical Cardiometry (EC) Stroke Volume Variation (SVV) in comparison to Central Venous Pressure (CVP) for guiding intraoperative fluids. Secondarily effects on outcomes. Patients and Methods: 41 adult patients undergoing pancreatico-duodenectomy (1 excluded) were randomly assigned to SVV gp (n=20) and CVP gp (n=20). Ringer’s Acetate infused intraoperative initial bolus 6 mL/kg then 3-6 ml/kg/h for both groups to keep SVV < 12% in SVV group or CVP 5-8 mmHg in CVP group, boluses of 3 ml/kg (max; 20 ml/kg) Albumin 5% if SVV persists > 12% in SVV group or CVP ≤5 mmHg in CVP group. SVV %, Thoracic Fluid Content (TFC) (%), Corrected Flow Time (FTc) (msec.), Systemic Vascular Resistance (SVR) dyn. sec.cm-5, Mean invasive blood pressure (MIBP) (mmHg), and fluid administered were recorded. Results: The total amount of Ringer acetate was 4550.00±916.23 Vs. 5775.00±678.14 ml, P ≤ 0.001 and albumin 5% 531.25± 85.39 Vs. 794.12± 237.75 ml, p≤ 0.001 in SVV and CVP groups respectively. The mean TFC was greater in the CVP group than SVV group; (27.99 ± 4.55 Vs 31.47 ± 4.73%; P= 0 .02). Partial pressure of oxygen (PaO2) and serum hemoglobin level were significantly better in SVV than CVP group. 13Vs 14 patients required noradrenaline support in SVV Vs CVP group (p=1.01). Conclusions: Significant reduction in the intraoperative volumes of both crystalloid and colloid, better postoperative oxygenation and serum hemoglobin as well as a reduction in thoracic fluid content in patients managed by SVV fluid managed protocol.