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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 508-515
DOI: 10.1055/s-0043-1771364
Original Article

Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial

Janani Gopal 
1   Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Shashi Srivastava 
1   Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Nidhi Singh 
1   Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Rudrashish Haldar 
1   Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Ruchi Verma 
1   Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Devendra Gupta 
1   Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Prabhakar Mishra 
2   Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract

Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries.

Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed.

Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables.

Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups.

Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.

Keywords

central venous pressure (CVP) - fluids - goal-directed fluid therapy (GDFT) - neurosurgery - pulse pressure variance (PPV) - supratentorial

Authors' Contributions

J.G. contributed to the enrolment of patients, acquisition of data, analysis, interpretation of data, drafting, critical revision of the manuscript, and approval of final manuscript. S.S. contributed to the study concept and design, analysis, interpretation of data, drafting and critical revision of the manuscript, study supervision, and approval of final manuscript. N.S. contributed to the analysis, interpretation of data, drafting and critical revision of the manuscript, and approval of final manuscript. R.H. contributed to the study concept and design, study supervision, drafting and critical revision of the manuscript, and approval of final manuscript. R.V. contributed to the study concept and design, enrolment of patients, analysis, interpretation of data, drafting and critical revision of the manuscript, study supervision, and approval of final manuscript. D.G. contributed to the study concept and design, drafting and critical revision of the manuscript, approval of final manuscript, and study supervision. P.M. contributed to the study concept and design, statistical analysis and interpretation of data, critical revision of the manuscript, and approval of final manuscript.


Prior Presentation

This paper was presented as a poster (virtual) at the International Anesthesia Research Society (IARS) 2022 annual meeting, March 17–20, 2022, in Hawaii, USA.


Ethical Approval

This study received the Institutional Ethics Committee approval under the following ID: 2018-188-MD-107. All research participants were treated with appropriate ethical standards, as per the Helsinki declaration. Clinical Trials Registry, India registration number: CTRI/2019/04/018746.




Publication History

Article published online:
22 September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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