ABSTRACT : Dynamic variables predict fluid responsiveness and may improve fluid management during surgery. We investigated whether displaying the variability in the pulse oximeterplethysmogram (pleth variability index; PVI) would guide intraoperative fluid management and improve circulation as assessed by lactate levels.

METHODS : Sixty patients scheduled for major abdominal surgery were randomized into 2 groups to compare intraoperative PVI-directed fluid management (PVI group) versus standard care (control group). After the induction of general anesthesia, the PVI group received a 500-mL crystalloid bolus and a crystalloid infusion of 2 mL/kg/h. Colloids of 250 mL were administered if the PVI was ≥13%. Vasoactive drug support was given to maintain the mean arterial pressure (MAP) above 65 mm Hg. In the control group, an infusion of 500 mL of crystalloids was followed by fluid management on the basis of fluid challenges and their effects on MAP and central venous pressure. Amount of fluid given, Lactate levels and hemodynamic data were recorded prospectively.

RESULTS : Intraoperative crystalloids and total volume infused were significantly lower in the goal-directed PVI group (p< 0.05). Lactate levels were lower in the PVI group 6 hours post surgery.

CONCLUSIONS : PVI-based goal-directed fluid management reduced the volume of intraoperative fluid infused and reduced postoperative lactate levels.