Pulse Pressure Variation-Guided Fluid Therapy during Supratentorial Brain Tumour Excision: A Randomized Controlled Trial

Ahmed Hasanin; Tarek Zanata; Safinaz Osman; Yasser Abdelwahab; Rania Samer; Mohamed Mahmoud; Mona Elsherbiny; Khaled Elshafaei; Fatma Morsy; Amina Omran

doi:10.3889/oamjms.2019.682

Authors

Ahmed Hasanin Department of Anesthesia, Cairo University, Cairo, Egypt
Tarek Zanata Department of Anesthesia, Nasser Institute, Cairo, Egypt
Safinaz Osman Department of Anesthesia, Cairo University, Cairo, Egypt
Yasser Abdelwahab Department of Anesthesia, Cairo University, Cairo, Egypt
Rania Samer Department of Anesthesia, Cairo University, Cairo, Egypt
Mohamed Mahmoud Department of Anesthesia, Cairo University, Cairo, Egypt
Mona Elsherbiny Department of Anesthesia, Cairo University, Cairo, Egypt
Khaled Elshafaei Department of Anesthesia, Cairo University, Cairo, Egypt
Fatma Morsy Department of Anesthesia, Cairo University, Cairo, Egypt
Amina Omran Department of Anesthesia, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2019.682

Keywords:

Goal-directed fluid therapy, Neurosurgical operations, Pulse pressure variation, Supratentorial mass excision

Abstract

BACKGROUND: Goal-directed fluid therapy (GDFT) improved patient outcomes in various surgical procedures; however, its role during mass brain resection was not well investigated.

AIM: In this study, we evaluated a simple protocol based on intermittent evaluation of pulse pressure variation for guiding fluid therapy during brain tumour resection.

METHODS: Sixty-one adult patients scheduled for supratentorial brain mass excision were randomized into either GDFT group (received intraoperative fluids guided by pulse pressure variation) and control group (received standard care). Both groups were compared according to the following: brain relaxation scale (BRS), mean arterial pressure, heart rate, urine output, intraoperative fluid intake, postoperative serum lactate, and length of hospital stay.

RESULTS: Demographic data, cardiovascular data (mean arterial pressure and heart rate), and BRS were comparable between both groups. GDFT group received more intraoperative fluids {3155 (452) mL vs 2790 (443) mL, P = 0.002}, had higher urine output {2019 (449) mL vs 1410 (382) mL, P < 0.001}, and had lower serum lactate {0.9 (1) mmol versus 2.5 (1.1) mmol, P = 0.03} compared to control group.

CONCLUSION: In conclusion, PPV-guided fluid therapy during supratentorial mass excision, increased intraoperative fluids, and improved peripheral perfusion without increasing brain swelling.