Effects of continuous infusion of noradrenaline combined with goal-directed haemodynamic therapy on inflammatory response and organ perfusion in patients undergoing brain tumour resection: a randomised controlled clinical trial

Controlled hypotension is commonly used in neurosurgical procedures, but its excessive use has been well documented to cause postoperative hypoperfusion of vital organs. However, the optimal haemodynamic management strategy to mitigate this risk during intracranial tumour resection remains unclear. This study aimed to explore the hypothesis that continuous noradrenaline infusion (CNI) more effectively mitigates postoperative systemic inflammatory responses and improves organ perfusion status in patients undergoing craniotomy for intracranial tumour resection, compared with intermittent bolus administration (IBA). This study was a single-centre, prospective, randomised, clinical controlled trial. We evaluated patients undergoing elective supine craniotomy for tumour resection, comparing CNI with IBA. The primary endpoint was defined as the composite outcome of systemic inflammatory response syndrome (SIRS) accompanied by at least one organ dysfunction within 7 postoperative days. Secondary outcomes included components of the primary endpoint, intraoperative fluid balance, haemodynamic parameters, and postoperative inflammatory markers. Among 116 surgical patients (58 per group) with comparable baseline and intraoperative parameters, the IBA group showed significantly higher postoperative incidence rates of SIRS (46.6% vs 27.6%, P = 0.034), at least one organ dysfunction (31.0% vs 15.5%, P = 0.048), and composite adverse outcomes (24.1% vs 10.3%, P = 0.049). The CNI group maintained a higher peak CVP ( P = 0.021) and better MAP profiles, including higher intraoperative nadir and mean MAP values ( P < 0.001 and P = 0.013, respectively) and less fluctuation ( P < 0.001). Intraoperative infused fluid, total fluid intake and net fluid balance were also distinctly decreased in the CNI group ( P = 0.016, P = 0.031, and P < 0.001, respectively). In patients undergoing brain tumour resection, continuous noradrenaline infusion (CNI) was associated with more stable intraoperative haemodynamics and lower postoperative inflammatory‑related laboratory markers relative to intermittent bolus administration (IBA). Chinese Clinical Trial Registry, ChiCTR2400084337, registered on May 14, 2024. Retrospectively registered. www.chictr.org.cn