Effects Of Intraoperative Fluid Management On Extravascular Lung Water And Postoperative Outcomes In Patients Undergoing Radical Esophagectomy

Backgroud: Intraoperative fluid management is one of the key element in perioperative practice of surgery and anesthesia. The optimal fluid management for keeping blood volume balance without evoking pulmonary edema is still unclear, particularly in thoracic surgery. PiCCO (pulse-induced contour cardiac output), a new method based on a single indicator thermodilution, allows the measurement of cardiac output (CO), intrathoracic blood volume (ITBV), global end-diastolic volume index(GEDI) and extravascular lung water (EVLW). In our study, we assessed the impacts of three intraoperative fluid regimens on EVLW and postoperative outcomes in patients undergoing radical esophagectomy.Methods: Thirty-one patients, ASAâ… toâ…¢, aged 40-65 years, undergoing radical esophagectomy, were allocated randomly into three groups: groupâ… (5ml/kg/h fluid, n=11); groupâ…¡(10ml/kg/h, n=10) and groupâ…¢(15ml/kg/h fluid, n=10). Both lactated Ringer's solution and 6% HES were administered at ratio 1:1 in each group. PiCCO catheters were introduced in local anesthesia before induction. EVLW, EVLI, PVPI, MAP, CVP, CO, CI, ITBV, ITBI, GEDI, GEF and SRV were monitored and recorded before induction of anesthesia (T₀), after right lateral position (T₁), at the beginning of operation (T₂), after one-lung ventilation (OLV) for 10rain (T₃), after two-lung ventilation for 10 min (T₄), at the end of operation (T₅), after supine position (T₆) and 2 hours after surgery (T₇). Chestâ…©-rays were performed before operation and on the 3rd postoperative day, and were evaluated by the same radiologist blindly. PONV, pain visual analog scale score (VAS score), time to postoperative food intake, time to thoracic drainage tube withdrawal and postoperative hospital stay were observed.Results: There were no significant differences in demographics, the durations of anesthesia, mechanical ventilation and surgery. There were no significant differences in EVLW,EVLWI,PVPI and ITBV at each observed time in three groups. However, GEF in groupâ…¡at T₁, T₃～T₇ were higher than that in groupâ… (about increased 21.1%), GEF in groupâ…¢increased 13.0% than in groupâ… at T₁, T₅～T₇. (P＜0.05) , and CO was also ,but no significant. Patients in groupâ…¡and groupâ…¢had significantly shorter time to postoperative food intake than that in groupâ… ( 6.3±0.8,6.7±0.9,7.5±1.4 days, respectively, P＜0.05). There was no significant difference in hospital stay among three groups (P＞0.05 ).Conclusions: we suggested that infusions of 5～15ml/kg/h fluid have little effect on EVLW in the patients undergoing esophagectomy, GEF and CO could be increased during administrations of 10～15ml/kg/h, which might improve tissue infusion, be benefit of postoperative food intake and outcomes.