Haemodynamic monitoring by application of transpulmonary thermodilution in patients with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with a pronounced perioperative fluid shift and organ dysfunction. In this monocentric, retrospective before-and-after study, we studied the impact of advanced haemodynamic monitoring by transpulmonary thermodilution (TPTD)-guided treatment on fluid management. Methods: With ethics approval, 54 consecutive patients (2014 - 2016), monitored by TPTD with integrated pulse contour analysis (PiCCO(2)(TM), Pulsion Medical Systems, Feldkirchen, Germany) immediately after induction of anaesthesia, and a control group of 59 patients (2009 - 2013) monitored conventionally (CONV, arterial and central venous catheter) were studied. Results: Groups had similar patient characteristics. The intraoperative fluid intake was comparable between groups. On ICU admission, the Simplified Acute Physiology Score II was lower in the TPTD group (29 +/- 8 vs. 34 +/- 11, p = 0.004). The TPTD group received less fluids from the 2nd to the 4th postoperative day (POD, 2nd POD: 3.7 L (95 % confidence intervals: 2.3; 5.0) vs. 5.5 L (4.3; 6.6), p < 0.05; 3rd POD: 2.7 L (0.6; 3.9) vs. 4.4 L (3.1; 5.6), p < 0.05; 4th POD: 0.9 L (0.0; 2.7) vs. 3.3 L (1.8; 4.7), p < 0.05). The cumulative fluid balance was less positive on the 4th POD in the TPTD group (-4.2 L (-6.2; -2.3) vs. -0.5 L (-2.4; 1.4), p = 0.006). Organ-dysfunction parameters, mortality, the length of hospitalisation and the patients' stay on the intensive care unit (ICU) were not different. Conclusions: The perioperative use of TPTD was associated with a better organ function on ICU admission and a less positive fluid balance on Day 4 after surgery, which could be associated with an outcome advantage in patients undergoing CRS and HIPEC.