학술논문
The Effect of Targeted Fluid Therapy with PVI on Acute Kidney Injury in Laparoscopic Colorectal Surgery/Laparoskopik Kolorektal Cerrahide PVI ile Hedefe Yonelik Sivi Tedavisinin Akut Bobrek Hasari Uzerine Etkisi
RESEARCH ARTICLE/ARASTIRMA MAKALESI: SURGICAL MEDICAL SCIENCES/CERRAHI TIP BILIMLERI
RESEARCH ARTICLE/ARASTIRMA MAKALESI: SURGICAL MEDICAL SCIENCES/CERRAHI TIP BILIMLERI
Document Type
Clinical report
Source
Journal of Ankara University Faculty of Medicine. September 2023, Vol. 76 Issue 3, p271, 7 p.
Subject
Language
English
Abstract
Giris Laparoskopik girisimler, literaturde bircok avantaji nedeni ile gunumuzde siklikla tercih edilse de intraabdominal basinc artisina bagli olumsuz sistemik etkileri bulunmaktadir (1). intraabdominal basinc artisi sonucu sistemik vaskuler direnc (SVR) [...]
Objectives: Laparoscopic approaches are preferred for colorectal surgeries because they have proven advantages in the literature. However, increased intra-abdominal pressure and hypo/hypervolemia adversely affect tissue perfusion. In this study, we aimed to improve postoperative outcomes with targeted fluid therapy using Pleth variability index (PVI) and to demonstrate its effect on kidneys using neutrophil gelatinase associated lipocalin (NGAL). Materials and Methods: This study was a prospective randomized control, single-centred study. Twenty-nine patients who underwent elective laparoscopic colorectal surgery were included. Patients were randomized into 2 groups, as Group-1 receiving targeted fluid therapy with PVI (n=15) and Group 2 receiving conventional fluid therapy (n=14). 500 mL of crystalloid bolus and 2 mL/kg/hour of maintenance fluid were applied to the PVI group. When the PVI>14%, a 250 mL of crystalloid bolus was administered. In the group receiving, conventional fluid therapy '4-2-1 rule' was used. Plasma NGAL samples were received at pre-insufflation (TO), post-insufflation 6th (T1) and 12th (T2) hours. Results: When the given fluids were compared between the groups, we detected significantly diminished results for Group 1 (p Conclusion: Targeted fluid therapy with PVI had no significant effect on NGAL associated acute kidney injury. Nevertheless, there were no postoperative complications in these patients. We think that fluid therapy with PVI can be used in laparoscopic colorectal surgeries to avoid complications caused by fluid load. Key Words: Laparoscopic Colorectal Surgery, Acute Kidney Injury, PVI, NGAL Amac: Kolorektal cerrahilerde, laparoskopik uygulamalar, literaturde kanitlanmis bircok avantaji olmasi nedeniyle tercih edilmektedir. Ancak intraabdominal basinc artisi ve hipo/hipervolemi doku perfuzyonunu olumsuz etkilemektedir. Bu calismada, Pleth degiskenlik indeksi (Pleth variability index-PVI) monitorizasyonu ile hedefe yonelik sivi tedavisi yaparak hem postoperatif sonuclari iyilestirmeyi hem de notrofil jelatinaz iliskili lipokalini (NGAL) kullanarak bu yaklasimin bobrekler uzerindeki etkisini gostermeyi amacladik. Gerec ve Yontem: Bu calisma tip fakultemizin genel cerrahi ameliyathanelerinde, prospektif randomize kontrollu, tek merkezli olarak gerceklestirildi. Elektif laparoskopik kolorektal cerrahi gecirmis, 29 hasta dahil edildi. Hastalar, Grup 1 (n=15) PVI ile hedefe yonelik sivi tedavisi alanlar ve Grup 2 (n=14), konvansiyonel sivi tedavisi alanlar seklinde randomize edildi. Genel anestezi induksiyonu sonrasi PVI grubuna 500 mL kristaloid bolusu ve 2 mL/kg/saat idame sivi uygulandi. PVI>%14 oldugunda 250 ml_ kristaloid bolusu verildi. Standart sivi tedavisi alan grupta ise 4-2-1 kuralina gore konvansiyonel sivi tedavisi yapildi. Butun hastalarda plazma NGAL ornekleri insuflasyon oncesi (TO), insuflasyon sonrasi 6. (Tl) ve 12. (T2) saatlerde alindi. Bulgular: Gruplar arasindaki verilen sivilar karsilastirildiginda Grup 1 'de verilen sivi volumu anlamli olarak daha az bulundu (p Sonuc: PVI ile hedefe yonelik sivi tedavisinin, NGAL ile gosterilebilen akut bobrek hasari uzerine, belirgin etkisi olmadi. Bununla birlikte bu hastalarda postoperatif komplikasyon gorulmedi. Laparoskopik kolorektal cerrahilerde PVI monitorizasyonu ile sivi tedavisinin, sivi yukunun getirdigi komplikasyonlardan kacinmak amaci ile kullanilabilecegini dusunmekteyiz. Anahtar Kelimeler: Laparoskopik Kolorektal Cerrahi, Akut Bobrek Hasari, PVI, NGAL
Objectives: Laparoscopic approaches are preferred for colorectal surgeries because they have proven advantages in the literature. However, increased intra-abdominal pressure and hypo/hypervolemia adversely affect tissue perfusion. In this study, we aimed to improve postoperative outcomes with targeted fluid therapy using Pleth variability index (PVI) and to demonstrate its effect on kidneys using neutrophil gelatinase associated lipocalin (NGAL). Materials and Methods: This study was a prospective randomized control, single-centred study. Twenty-nine patients who underwent elective laparoscopic colorectal surgery were included. Patients were randomized into 2 groups, as Group-1 receiving targeted fluid therapy with PVI (n=15) and Group 2 receiving conventional fluid therapy (n=14). 500 mL of crystalloid bolus and 2 mL/kg/hour of maintenance fluid were applied to the PVI group. When the PVI>14%, a 250 mL of crystalloid bolus was administered. In the group receiving, conventional fluid therapy '4-2-1 rule' was used. Plasma NGAL samples were received at pre-insufflation (TO), post-insufflation 6th (T1) and 12th (T2) hours. Results: When the given fluids were compared between the groups, we detected significantly diminished results for Group 1 (p Conclusion: Targeted fluid therapy with PVI had no significant effect on NGAL associated acute kidney injury. Nevertheless, there were no postoperative complications in these patients. We think that fluid therapy with PVI can be used in laparoscopic colorectal surgeries to avoid complications caused by fluid load. Key Words: Laparoscopic Colorectal Surgery, Acute Kidney Injury, PVI, NGAL Amac: Kolorektal cerrahilerde, laparoskopik uygulamalar, literaturde kanitlanmis bircok avantaji olmasi nedeniyle tercih edilmektedir. Ancak intraabdominal basinc artisi ve hipo/hipervolemi doku perfuzyonunu olumsuz etkilemektedir. Bu calismada, Pleth degiskenlik indeksi (Pleth variability index-PVI) monitorizasyonu ile hedefe yonelik sivi tedavisi yaparak hem postoperatif sonuclari iyilestirmeyi hem de notrofil jelatinaz iliskili lipokalini (NGAL) kullanarak bu yaklasimin bobrekler uzerindeki etkisini gostermeyi amacladik. Gerec ve Yontem: Bu calisma tip fakultemizin genel cerrahi ameliyathanelerinde, prospektif randomize kontrollu, tek merkezli olarak gerceklestirildi. Elektif laparoskopik kolorektal cerrahi gecirmis, 29 hasta dahil edildi. Hastalar, Grup 1 (n=15) PVI ile hedefe yonelik sivi tedavisi alanlar ve Grup 2 (n=14), konvansiyonel sivi tedavisi alanlar seklinde randomize edildi. Genel anestezi induksiyonu sonrasi PVI grubuna 500 mL kristaloid bolusu ve 2 mL/kg/saat idame sivi uygulandi. PVI>%14 oldugunda 250 ml_ kristaloid bolusu verildi. Standart sivi tedavisi alan grupta ise 4-2-1 kuralina gore konvansiyonel sivi tedavisi yapildi. Butun hastalarda plazma NGAL ornekleri insuflasyon oncesi (TO), insuflasyon sonrasi 6. (Tl) ve 12. (T2) saatlerde alindi. Bulgular: Gruplar arasindaki verilen sivilar karsilastirildiginda Grup 1 'de verilen sivi volumu anlamli olarak daha az bulundu (p Sonuc: PVI ile hedefe yonelik sivi tedavisinin, NGAL ile gosterilebilen akut bobrek hasari uzerine, belirgin etkisi olmadi. Bununla birlikte bu hastalarda postoperatif komplikasyon gorulmedi. Laparoskopik kolorektal cerrahilerde PVI monitorizasyonu ile sivi tedavisinin, sivi yukunun getirdigi komplikasyonlardan kacinmak amaci ile kullanilabilecegini dusunmekteyiz. Anahtar Kelimeler: Laparoskopik Kolorektal Cerrahi, Akut Bobrek Hasari, PVI, NGAL