Effect of fluid management guided by stroke volume variation on postoperative outcomes of patients undergoing lung transplantation

Objective To evaluate the effect of fluid management guided by stroke volume variation(SVV)on postoperative outcomes of patients undergoing lung transplantation. Methods Thirty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes, aged 51-78 yr, with body mass index of 18-25 kg/m2, undergoing elective double-lung transplantation, were randomized into 2 groups(n=15 each)using a random number table: SVV group and central venous pressure(CVP)group.SVV was maintained at 8%-13% in group SVV, and CVP at 8-12 cmH2O in group CVP.Mean arterial pressure, heart rate, CVP, cardiac output, pulmonary arterial pressure, SVV and systemic vascular resistance index were recorded at 30 min after anesthesia induction(T0), 30 min of one-lung ventilation on one side(T1), 30 min after pulmonary artery occlusion(T2), 30 min after pulmonary artery unclamping(T3), 30 min of one-lung ventilation on the contralateral side(T4), 30 min after pulmonary artery occlusion(T5), 30 min after pulmonary artery unclamping(T6)and closing the chest(T7). The amount of vasoactive drugs consumed and net volume of fluid infused during each period were recorded.The oxygenation index and blood lactic acid concentrations were measured at each time point and 2 h following admission to intensive care unit(ICU)(T8). The extubation time and length of ICU stay were recorded, and the occurrence of complications was observed. Results Compared with group CVP, CVP at T2, 3, 5-6 and SVV at T7 were significantly increased, CVP at T7, pulmonary arterial pressure at T2, 5, SVV at T2, 3, 5-6 and systemic vascular resistance index at T2-6 were decreased, the net volume of fluid infused during both pulmonary artery occlusion periods was increased, the net volume of fluid infused was reduced during the pulmonary artery unclamping periods, the consumption of norepinephrine was decreased, oxygenation index was increased at T3-4, 6, 8, blood lactic acid concentrations were decreased at T2-6, 8, and the extubation time and length of ICU stay were shortened in group SVV(P 0.05). Conclusion SVV-guided fluid management can promote postoperative outcomes of patients undergoing lung transplantation. Key words: Stroke volume; Vascular capacitance; Lung transplantation; Postoperative complications