Effect of Goal-directed Fluid Therapy on the Shedding of the Glycocalyx Layer in Retroperitoneal Tumour Resection.

Abstract

OBJECTIVE:

To evaluate the effects of different stroke volume variation (SVV) targets on endothelial glycocalyx (EG) shedding.

STUDY DESIGN:

Randomised controlled trial.

PLACE AND DURATION OF STUDY:

Department of Anaesthesiology, Peking University International Hospital, Beijing, China, from February to June 2018.

METHODOLOGY:

Patients undergoing elective retroperitoneal tumour resection were assigned to one of two groups. SVV 9% group (n=40), who received a more traditional (liberal) fluid therapy with SVV ≤9%; and the SVV 14% group (n=40), received restrictive fluid therapy with SVV ≤14%. Patients' serum concentrations of syndecan-1 (SDC-1), interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were measured at the time that patients entered the operating theatre; at 1- and 4-hours following initiation of the surgery; and at 24- and 72-hours post-surgery. Postoperative complications, and one-year survival rates were also noted.

RESULTS:

Perioperative serum SDC-1, IL-6 and TNF-α concentrations were significantly elevated in both groups, which were more pronounced in SVV 9% (p = 0.028, <0.001, and <0.001 respectively). A positive correlation was observed between SDC-1 and TNF-α, L-6, and infusion volume, respectively. Postoperative complications, including fever and blood transfusion, were more aggravated in SVV 9% than those in SVV 14% (80% vs. 59%, and 45% vs. 23.1%, both p <0.05). However, no significant difference in the one-year survival rate was observed.

CONCLUSION:

Using SVV 14% as a target for guiding fluid therapy in elective retroperitoneal tumour resection was associated with reduced perioperative glycocalyx shedding, ameliorated inflammatory response, and reduced postoperative complications. Key Words: Randomised controlled trial, Retroperitoneal neoplasms, Glycocalyx, Tumour necrosis factor-alpha, Interleukin-6, Fluid therapy, Stroke volume.

• Authors: Xiaoyu Wang, Yi Duan, Zhifeng Gao, Jie Gu
• Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (J Coll Physicians Surg Pak) Vol. 31 Issue 10 Pg. 1179-1185 (Oct 2021) ISSN: 1681-7168 [Electronic] Pakistan
• PMID: 34601838 (Publication Type: Journal Article)

Topics

• Fluid Therapy
• Glycocalyx
• Goals
• Humans
• Retroperitoneal Neoplasms (surgery)
• Stroke Volume