الفهرس 
Goal directed fluid therapy using electrical cardiometry versus masimo radical 7 evidenced by serum lactate level in major abdominal surgery
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Abstract
Optimization of intravascular volume during major abdominal surgery and avoiding hypo or hypervolemia using different cardiac output monitors is associated with better intraoperative hemodynamic stability and significantly lower incidence of complications. The aim of the current study was to evaluate SVV measured by electrical cardiometry as a goal to direct fluid therapy in major abdominal surgeries compared to PVI measured by Masimo radical 7 apparatus guided by serum lactate level.
This randomized comparative study was conducted on 70 patients undergoing major abdominal surgery. They were divided into two equal groups: ICON group (n=32) and MASIMO group (n=31), with the same inclusion and exclusion criteria.
The two groups were matched regarding age and sex. No statistically significant difference was found between groups according to heart rate, mean arterial blood pressure, central venous pressure and urine output from T1 to T4, with p-value.
On comparing flow time corrected, cardiac output and cardiac index in different time intervals T1, T2, T3 and T4, there was no statistically significant difference between T1 and other measurements, with p-value >0.05.
In the ICON group on comparing stroke volume in different time points, there was no statistically significant difference between T1 and other measurements, with p-value >0.05.
There was no significant difference between ICON group and MASIMO group according to lactate level, with p-value (p>0.05 NS) In the ICON group on comparing stroke volume variation with each of measurements, the mean stroke volume at T1 was 9.81±1.86, at T2 was 11.33±2.15, at T3 was 9.27±1.76 and at T4 was 12.36±2.35. There was a statistically significant difference between T1 vs. T4, with p= 0.039.
In the Masimo group on comparing stroke volume variation with each of measurements, the mean stroke volume at T1 was 11.88±2.49, at T2 was 13.50±2.84, at T3 was 12.96±2.72 and at T4 was 14.04±2.95. There was a statistically significant difference between T1 vs. T4, with p= 0.024.
In the Masimo group on comparing PI (perfusion index) with each of measurements, there was a statistically significant difference between T1 vs. T3, with p= 0.011and T1 vs. T4 regarding the mean stroke volume with p= 0.017.
There were a statistically significant positive correlation between Lactate level and stroke volume variation at T1, T2, T3 and T4 among ICON group, with p-value (p<0.05).
According to the current study findings there were a statistically significant positive correlation between Lactate level and plethysmography variability index at T1, T2, T3 and T4 among MASIMO group, with p-value (p<0.05). Reduced lactate levels in PVI-guided patients suggests that PVI-guided fluid management may lead to fluid administration that was tailored to each individual patient’s needs.
In conclusion both ICON and MASIMO could be guide to GDFT. A statistically significant positive correlation between Lactate level and stroke volume variation at T1, T2, T3 and T4 among ICON group, and a statistically significant positive correlation between lactate level and PVI at T1,T2,T3 and T4 among Masimo group.