Two Cut-Off Values of Plethysmographic Variability Index to Guide Intraoperative Fluid Therapy on Serum Lactate in Patients Undergoing Excision of Supra-Tentorial Brain Tumors

Cairo University32 enrolled

Overview

This study aimed to compare two cut-off values of plethysmographic variability index (PVI) -guided fluid therapy in patients undergoing supra-tentorial mass excision regarding immediate postoperative serum lactate.

Fluid therapy in patients undergoing craniotomy is very critical; hypovolemia might decrease cerebral perfusion, while fluid overinfusion might cause brain swelling that impairs surgical removal of lesions. The plethysmographic variability index (PVI) is one of the dynamic indices of fluid responsiveness, a simple, automatic, non-invasive, and continuous method based on calculating changes in the perfusion index (PI).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Cut-Off Value Plethysmographic Variability Index Intraoperative Fluid Therapy

Interventions

Fluid TherapyOTHER

Patients would receive the second round of fluid loading if the Plethysmographic Variability Index (PVI) was 14%.

Fluid TherapyOTHER

Patients would receive the second round of fluid loading if the Plethysmographic Variability Index (PVI) was 20%.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age above 18 years old. * Both sexes. * Patients scheduled for supra-tentorial brain tumor excision. Exclusion Criteria: * Arrhythmias. * Pulmonary hypertension. * Impaired cardiac contractility. * Impaired liver or kidney function. * Low lung compliance. * Body mass index above 40. * Intra-operative hemodynamic instability on vasopressors or inotropes. * Peripheral arterial occlusive diseases. * Hand injuries or burns that preclude the application of the Masimo device probe.

Outcomes

Primary Outcomes

Serum lactate level

Serum lactate level was measured at the end of surgery (immediately after extubation).

Time frame: 24 hours postoperatively

Secondary Outcomes

Brain Relaxation scale

The neurosurgeon assessed the Brain Relaxation scale at three time intervals: with dural opening, after two hours, and before dural closure. A 4-point scale will be performed as follows: grade 1, perfectly relaxed; grade 2, satisfactorily relaxed; grade 3, firm brain; grade 4, bulging brain.

Time frame: Intraoperatively

Heart rate

Heart rate was measured immediately after fluid loading and every 5 minutes for 20 minutes.

Time frame: 20 minutes after fluid loading

Mean arterial pressure

Mean arterial pressure was measured immediately after fluid loading and every 5 minutes for 20 minutes.

Time frame: 20 minutes after fluid loading

Length of hospital stay

Length of hospital stay was recorded from admission till discharge from the hospital.

Time frame: Till discharge from the hospital (Up to 2 weeks)