Impact of intraoperative goal-directed fluid therapy on tissue oxygen saturation and major morbidity in patients undergoing thoracoscopic lung resection: a randomized controlled trial

Background Incision healing after thoracoscopic lung resection, resistance to infection, and gastrointestinal recovery are dependent on tissue perfusion and oxygenation. OLV decreases blood flow and tissue oxygen partial pressure in the emblematic circulation, which in turn regulates tissue blood flow and local tissue oxygen diffusion. This study was aimed at investigating the effects of different fluid management methods on regional tissue oxygen saturation (rSO 2 ) and hemodynamics in patients undergoing thoracoscopic lung resection. Furthermore, we comparatively evaluated the effects of the different fluid management strategies on postoperative hospital stay and complications. Methods This is a prospective randomized controlled trial. Sixty patients scheduled for thoracoscopic lung resection are randomly allocated to receive either goal-directed fluid therapy (GDFT) or restrictive fluid therapy at a 1:1 ratio. The rSO 2 of each part, mean arterial pressure (MAP), heart rate, CI, and SVV were recorded before induction (T1), before one-lung ventilation (T2), 30 and 60 min after one-lung ventilation (T3 and T4, respectively), and at the end of surgery (T5). Radial artery blood gas analysis was performed at T1, T4, and T5 to record pH and lactic acid level. Furthermore, patients’ score on the Quality of Recovery-15 (QoR-15) scale and creatinine and urea nitrogen levels on the first postoperative day, postoperative hospital stay, postoperative nausea and vomiting, and complications were recorded. The primary outcome is the regional tissue oxygen saturation (rSO2) and hemodynamics during surgery. The secondary outcomes included postoperative hospital stay and complications. Results Compared with group C, the GDFT group had a significantly higher MAP and CI, lower SVV at T3 to T5 ( P < 0.05). In the GDFT group, the intraoperative crystalloid requirement and norepinephrine dose were lower and colloidal requirement and total volume of fluid infused were significantly higher ( P < 0.05). Furthermore, the renal rSO 2 at T3 to T4 and brachioradialis muscle rSO 2 at T4 to T5 in the group were significantly higher ( P < 0.05). The postoperative 24-h QoR-15 score was significantly higher in the GDFT group than in group C. Furthermore, the incidence of postoperative nausea and vomiting was significantly lower in the GDFT group than in group C ( P < 0.05). Conclusions GDFT can improve the intraoperative renal rSO 2 and brachioradialis muscle rSO 2 in patients undergoing thoracoscopic lung resection. It also can maintain hemodynamic stability, decrease the incidence of postoperative nausea and vomiting, and improve the quality of postoperative recovery. Trial registration: Chinese Clinical Trial Registry: ChiCTR2100050474. Registered on August 27 2021.