Goal-directed fluid therapy compared to liberal fluid therapy in patients subjected to colorectal surgery

Figures & data

Figure 1. The flow diagram of patient progress through the randomized trial.

Figure 2. Serum lactate during follow up among studied groups.

GDFT=Goal directed fluid therapy group, LFT= Liberal fluid therapy group

Figure 3. Serum creatinine during follow up among studied groups.

GDFT=Goal directed fluid therapy group, LFT= Liberal fluid therapy group

Table 1. Demographic data, type of surgery, and operative time comparing the two groups.

	GDFT (n = 50)	LFT (n = 50)	Pvalue
Age (years)	47.7 ± 9.7	48.1 ± 8.9	0.84
Sex
Male	33 (66%)	25 (50%)	0.105
Female	17 (34%)	25 (50%)
BMI (kg/m^2)	28.03 ± 3.91	26.95 ± 4.23	0.187
ASA
I	30 (60%)	31 (62%)	0.838
II	20 (40%)	19 (38%)
Type of surgery
Anorectal cancer	6 (12%)	12 (24%)	0.213
Rectum cancer	0	1 (2%)
Hemicolectomy	25 (50%)	26 (52%)
Sigmoid cancer	15 (30%)	10 (20%)
Total colectomy	4 (8%)	1 (2%)
Operative time (h)	3.22 ± 0.764	3.10 ± 0.789	0.442

Data is expressed as mean and standard deviation or as percentage and frequency. P is significant when < 0.05. n=Number of patients, BMI=Body mass index, ASA= American Society of Anesthesiologists, GDFT=Goal directed fluid therapy group, LFT=liberal fluid therapy group.

Table 2. Clinical parameters.

	GDFT (n = 50)	LFT (n = 50)	P value
H.R. (bpm)
T1	80.66 ± 9.15	80.20 ± 8.74	0.798
T2	80.3 ± 8.7	77.78 ± 12.86	0.244
T3	77.06 ± 8.26	79.48 ± 8.98	0.325
T4	79.52 ± 8.19	79.22 ± 10.15	0.871
T5	83.66 ± 6.60	85.80 ± 8.26	0.156
MAP (mmHg)
T1	90.32 ± 6.29	88.06 ± 8.96	0.148
T2	86.02 ± 9.03	83.46 ± 9.09	0.161
T3	91.92 ± 8.06	90.72 ± 7.05	0.430
T4	83.48 ± 9.70	86.72 ± 8.72	0.082
T5	90.72 ± 9.42	92.36 ± 5.93	0.300
CVP (cm H2O)
T1	4.94 ± 1.15	5.40 ± 1.87	0.142
T2	7.50 ± 1.28	8.08 ± 2.20	0.111
T3	10.30 ± 1.58	10.58 ± 1.60	0.382
T4	10.62 ± 1.61	11.10 ± 1.68	0.149
T5	11.16 ± 1.28	11.64 ± 1.57	0.098
SV(ml)
T1	71.98 ± 6.66	72.42 ± 825	0.770
T2	68.56 ± 6.46	70.22 ± 6.47	0.202
T3	77.82 ± 5.92	79.62 ± 6.98	0.168
T4	73.80 ± 6.66	74.88 ± 5.95	0.395
T5	75.88 ± 5.26	77.54 ± 5.52	0.127

Data is expressed as mean and standard deviation. P is significant when <0.05. n=Number of patients, HR=Heart rate, MAP= Mean arterial pressure, CVP=Central venous pressure, SV= Stroke volume, (T1)=after induction of anesthesia, (T2) = 30 min, (T3) = 60 min, (T4) = 90 min, (T5) = 120 min during surgery, GDFT=Goal directed fluid therapy group, LFT=liberal fluid therapy group.

Table 3. Clinical parameters (continue).

	GDFT (n = 50)	LFT (n = 50)	P value
SVV (%)
T1	11.18 ± 2.11	11.32 ± 1.53	0.705
T2	11.06 ± 2.34	11.24 ± 1.98	0.679
T3	10.54 ± 1.69	11.12 ± 2.24	0.147
T4	10.30 ± 1.92	10.82 ± 1.86	0.172
T5	10.0 ± 0.926	10.42 ± 2.05	0.190
COP (L/min)
T1	5.58 ± 0.905	5.68 ± 0.819	0.564
T2	5.38 ± 0.752	5.42 ± 0.928	0.813
T3	5.76 ± 0.687	5.94 ± 0.935	0.275
T4	5.66 ± 0.798	5.90 ± 0.863	0.152
T5	6.20 ± 0.534	6.28 ± 0.701	0.523
CI (L/min/m^2)
T1	2.98 ± 0.88	3.06 ± 0.424	0.438
T2	2.94 ± 0.314	3.02 ± 0.553	0.376
T3	3.16 ± 0.422	3.26 ± 0.443	0.251
T4	3.08 ± 0.528	3.16 ± 0.509	0.443
T5	3.28 ± 0.834	3.38 ± 0.490	0.467
TFC (kOhm^−1)
T1	30.98 ± 3.73	31.26 ± 4.87	0.748
T2	31.66 ± 3.19	32.84 ± 4.46	0.131
T3	33.18 ± 3.29	34.12 ± 4.19	0.216
T4	33.38 ± 4.27	34.64 ± 4.39	0.149
T5	36.92 ± 4.29	37.80 ± 4.78	0.335

Data is expressed as mean and standard deviation. P is significant when <0.05. n=Number of patients, SVV=Stroke volume variation, COP= Cardiac output, CI=Cardiac index, TFC= Thoracic fluid content, (T1)=after induction of anesthesia, (T2) = 30 min, (T3) = 60 min, (T4) = 90 min, (T5) = 120 min during surgery, GDFT=Goal directed fluid therapy group, LFT=liberal fluid therapy group.

Table 4. Fluid management.

	GDFT (n = 50)	LFT (n = 50)	P value
Crystalloid (ml)	2200(1300–2900)	2900(1500–4150)	<0.001
Voluven (ml)	450(100–1000)	400(100–1000)	0.208
Blood (ml)	500(250–1500)	500(400–1500)	0.427
Total fluids (ml)	3400(2000–4400)	3900(2650–5500)	0.001

Data is expressed as median (minimum-maximum). P is significant when <0.05. n=Number of patients, GDFT=Goal directed fluid therapy group, LFT=liberal fluid therapy group.

Table 5. Hypotensive episodes and ephedrine.

	GDFT (n = 50)	LFT (n = 50)	P value
Hypotensive episodes
None	33 (66%)	36 (72%)	0.793
1	15 (30%)	12 (24%)
2	2 (4%)	2 (4%)
Ephedrine bolus
None	37 (74%)	42 (84%)	0.425
1	11 (22%)	8 (16%)
2	1 (2%)	0
3	1 (2%)	0
Ephedrine total amount	10 (5–30)	10 (5–10)	0.08

Data is expressed as number and percentage or median (minimum-maximum). P is significant when < 0.05. n=Number of patients, GDFT=Goal directed fluid therapy group, LFT=liberal fluid therapy group.

Table 6. Complication distribution among studied groups.

	GDFT (n = 50)	LFT (n = 50)	P value
Burst abdomen	0(0%)	0(0%)
Paralytic ileus	1(2%)	2(4%)	0.558
Wound infection	2(4%)	3(6%)	0.646
AKI	1(2%)	2(4%)	0.558

Data is expressed as percentage and frequency. P is significant when < 0.05.