الفهرس 
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Abstract
Goal-directed fluid therapy which is based on the use of dynamic parameters to guide intravenous and inotropic therapy is frequently applied with the intention to optimize peri-operative hemodynamic profiles and maximize oxygen delivery in patients undergoing major abdominal surgery. Dynamic indices as stroke volume variability and pulse pressure variation have emerged as promising predictors in last decade, and have been proven to predict fluid responsiveness far better than static measures. Advanced hemodynamic monitoring is espoused as a means to achieve optimization of cardiac stroke volume (SVO) which defined as the endeavor to titrate i.v. fluids to achieve an ideal target stroke volume throughout surgery. Electrical Cardiometry™ is a method for the non-invasive determination of stroke volume (SV), cardiac output (CO), and other hemodynamic parameters in adults, children and neonates. We have conducted a prospective randomized study on one hundred and eighty-six patients of both sex undergoing cystectomy and urinary diversion in urology nephrology center, Mansoura university Patients were randomly assigned to one of two equal groups, according to computer-generated randomization sequence into: Stroke volume optimization group (SVopt group) and Central venous pressure dynamic group (CVPdyn group) and hemodynamic variables from electrical cardiometry was obtained such as stroke volume (SV), stroke volume variation (SVV), cardiac output (COP), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), thoracic fluid content (TFC), corrected flow time (FTC), index of contractility (ICON), systolic time ratio (STR), oxygen delivery (DO2) and oxygen delivery index (DO2I). There was a lower number of hypotensive episodes in SVopt group and subsequently less additional boluses of colloids with higher sensitivity, specificity, positive predictive value and area under the curve (AUC) when compared to CVPdyn group despite no differences in total perioperative fluids and complications in both groups. Also, there was no statistically significant difference between both group as regard incidence of complications as acute kidney injury (AKI), burst abdomen, pneumonia, intestinal obstruction, pulmonary edema and post-operative ventilation. Conclusion : Goal directed fluid therapy using stroke volume optimization had been associated with a significant reduction in number and severity of hypotensive episodes with maintenance of hemodynamic stability, adequate plasma volume status and achievement of maximal oxygenation (DO2I ˃ 550 ml/min/m2) when compared with dynamic central venous pressure, despite no differences in total perioperative fluids and complications in both groups.