Analysis of the results of the study of central hemodynamics and peripheral capillary blood flow at different modes of intraoperative fluid management

S.V. Kursov, K.I. Lizogub, M.V. Lizogub


The restrictive mode of intraoperative fluid ma­nagement and goal-directed fluid therapy (GDFT) at the present stage are the most common methods used as hemodynamic support during surgery. The restrictive regime is aimed at preventing the development of hemodilution coagulopathy and hyperhydratation, but at the same time, the formation of edema, abdominal compartment syndrome, renal dysfunction and respiratory distress syndrome. GDFT is used to prevent tissue and organ hypoperfusion. Each of the techniques has its advantages and disadvantages. Restrictive mode threatens the development of organ hypoperfusion. GDFT is associated with the use of synthetic colloidal plasma substitutes to support cardiac output, most often hydroxyethyl starch, which poses a risk for coagulopathy, kidney damage and anaphylactoid reactions. In clinical medicine, a significant number of complications is due to violations of capillary circulation, resulting in deterioration of reparative processes, decreased oxygen consumption and causes organ dysfunction, increases the length of stay of the patient at the department of intensive care and in the hospital in general, increases the cost of treatment. The aim of the investigation was a comparative study of the effect of two regimes of intraoperative fluid supply on the state of central hemodynamics and the magnitude of peripheral capillary blood flow in patients with malignant pathology of the bones of the lower extremities, who underwent traumatic surgical interventions in orthopedic oncology. The study included 70 patients aged 18 to 77 years, who underwent planned surgical interventions under combined anesthesia including spinal anesthesia with bupivacaine and intravenous propofol anesthesia. Two study groups have been formed. Patients of the first group (n = 35) were provided with a restrictive mode of intraoperative fluid administration. Patients in the second group (n = 35) underwent GDFT with careful monitoring of cardiac output and targeted support of cardiac stroke index at a level of less than 35 ml/m2 and mean arterial pressure at least 80 mmHg for young and middle-aged people, and not less than 90 mmHg for the elderly and senile persons. If in patients of the first group, cardiac preload was often modeled by norepinephrine infusion, then in patients of the second group it was maintained with short-term infusions of a hydroxyethyl starch solution. Each of the groups was divided into two subgroups: 1) patients under the age of 60 years (in both regimens of fluid maintenance, there were 25 such patients); 2) patients aged 60 years and older (in both regimens of fluid support, there were 10 such patients). Central hemodynamics was studied by the method of chest bioreactance. The state of peripheral capillary blood flow was assessed using a photoplethysmometric determination of the perfusion index (PI). The results of the study showed that under limited liquid support, there was a significant decrease in cardiac output, vascular tone, and peripheral capillary blood flow. Both in patients under 60 years of age, and in patients aged 60 years and older, the GDFT method provided significantly higher blood pressure, cardiac output and PI values at the traumatic stage of the operation and at the end of the study. All patients with a restrictive regime of fluid supply aged 60 years and older (100 %) required norepinephrine infusion to correct vascular tone and cardiac preload. Patients with GDFT did not need norepinephrine infusions. Using Pearson’s linear correlation analysis, a close relationship was found between the pulse pressure value and the PI (r = 0.866). The next most important indicators that determined the value of peripheral capillary perfusion were the level of systolic blood pressure (r = 0.69) and cardiac stroke index (0.533).


fluid resuscitation; restrictive regime; goal-direc­ted fluid therapy; central hemodynamics; perfusion index; combined anesthesia


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