Effects of the perioperative prevention of compensated shock during major abdominal surgery on the enhanced recovery after surgery

Objective Perioperative fluid therapy for shock resuscitation guided by only clinical evaluation may lead into the early stage of shock,which is compensated by the change in systemic vascular resistance or cardiac output. However,insufficient or excessive volume administration may disturb microcirculation,delay the return of postoperative bowel function and minimize the duration of unnecessary hospital stay. We hypothesized that the additional use of non-invasive hemodynamic guided perioperative fluid optimization for the prevention of compensated shock might enhance the recovery after surgery in major abdominal surgery patients. Methods One hundred elective major abdominal surgery patients were prospective randomly allocated to receive different perioperative hemodynamic management regimens. Control group (n=50) received traditional fluid therapy based on clinical and Holliday-Segar nomogram. PGDT group (n=50)received perioperative goal directed therapy (PGDT) protocol based on non-invasive guided intravenous fluid and inotropic support to maintain pleth variability index (PVI) less than 20%and estimated continuous cardiac index (esC CI)> 2. 5 L/min/m2. Serum lactate level was measured immediately before and after surgery. The treatment regimen was masked to the observers who collected the data of the return of the gastrointestinal function,the cost of treatment and the length of stay in hospital. Data were compared using unpaired t test. All data were expressed as mean±SD. Data were considered significant if p-value <0. 05.Results The returning of the bowel sound and the starting of soft diet therapy was significantly faster in the PGDT group (P <0. 001,P <0. 001,respectively). The overall cost of treatment was significantly lower(P=0. 023) and the length of stay in hospital was significantly shorter in the PGDT group (P=0. 003).However,the changes in blood lactate level immediately after surgery of both groups were not different.Conclusions Perioperative fluid optimization for the compensated shock prevention enhanced the recovery of postoperative bowel function and reduced the cost of treatment and length of stay in hospital in patients undergoing major abdominal surgery