Newly Published
Perioperative Medicine  |   March 2020
Individualized Fluid Management Using the Pleth Variability Index: A Randomized Clinical Trial
Author Notes
  • From the Anesthesiology and Critical Care Medicine Department (M.-O.F., S.L., W.G., G.D., J.-L.H.), the INSERM COMETE 1075 Unit, Orthopedic Department, (C.H.), and the Biostatistics Department (J.-J.P.), Normandy University, Caen University Hospital, Caen, France; Anesthesiology and Critical Care Medicine Department, Lille University Hospital, Lille, France (B.T., M.H.); Anesthesiology and Intensive Care Medicine Department, Hospital of Catholic Institute of Lille, Saint Philibert Hospital, Lomme, France (C.-E.B., V.C.); Anesthesiology and Critical Care Medicine Department, Rouen University Hospital, Charles Nicolle Hospital, Rouen, France (V.C.); Anesthesiology and Critical Care Department, Amiens University Hospital, Amiens, France (D.T., E.L.); and Research Unit on Simplified Care of Complex Surgical Patients, Jules Verne University of Picardy, Amiens, France (E.L.).
  • Caen University Hospital, Caen, France
  • Caen University Hospital, Caen, France
  • Amiens Picardie University Hospital, Amiens, France
  • Amiens Picardie University Hospital, Amiens, France
  • Lille University Hospital, Lille, France
  • Lille University Hospital, Lille, France
  • Hospital of Catholic Institute of Lille, Lomme, France
  • Clinical Research Department, Caen University Hospital
  • Clinical Research Department, Caen University Hospital
  • Clinical Research Department, Caen University Hospital
  • Clinical Research Department, Hospital of Catholic Institute of Lille
  • Clinical Research Department, Lille University Hospital
  • Clinical Research Department, Lille University Hospital
  • Clinical Research Department, Amiens Picardie University Hospital
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • J.-J.P. and J.-L.H. contributed equally to this article.
    J.-J.P. and J.-L.H. contributed equally to this article.×
  • Submitted for publication September 30, 2019. Accepted for publication February 20, 2020.
    Submitted for publication September 30, 2019. Accepted for publication February 20, 2020.×
  • *Members of the OPVI Trial Group are listed in the appendix.
    Members of the OPVI Trial Group are listed in the appendix.×
  • Correspondence: Address correspondence to Prof. Fischer: Pôle Réanimations Anesthésie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France. marcolivierfischer@yahoo.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   March 2020
Individualized Fluid Management Using the Pleth Variability Index: A Randomized Clinical Trial
Anesthesiology Newly Published on March 19, 2020. doi:https://doi.org/10.1097/ALN.0000000000003260
Anesthesiology Newly Published on March 19, 2020. doi:https://doi.org/10.1097/ALN.0000000000003260
Abstract

Background: The present trial was designed to assess whether individualized strategies of fluid administration using a noninvasive plethysmographic variability index could reduce the postoperative hospital length of stay and morbidity after intermediate-risk surgery.

Methods: This was a multicenter, randomized, nonblinded parallel-group clinical trial conducted in five hospitals. Adult patients in sinus rhythm having elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia were enrolled. Individualized hemodynamic management aimed to achieve a plethysmographic variability index under 13%, and the standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia. The primary outcome was the postoperative hospital length of stay decided by surgeons blinded to the group allocation of the patient.

Results: In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, −0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 μg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively.

Conclusions: Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications.

Editor’s Perspective:

What We Already Know about This Topic:

  • The role of guided fluid management remains unclear, with contradictory trial results.

  • The noninvasive plethysmographic variability index is one method of guiding fluid administration.

What This Article Tells Us That Is New:

  • The investigators randomized 447 moderate-risk major arthroplasty patients to plethysmographic-guided versus routine fluid management.

  • Fitness for discharge and actual hospital durations were essentially identical in each group. Complications were rare and similar in each group.

  • Plethysmographic-guided fluid management did not reduce the duration of hospitalization or complications in moderate-risk surgery patients.