Evaluation of efficacy of goal directed fluid therapy in pleural exfoliation surgery of tuberculosis patients under enhanced recovery after surgery mode

doi:10.19871/j.cnki.xfcrbzz.2023.04.006

Abstract

Abstract: Objective To explore the therapeutic value of GDFT in reducing pulmonary edema after pleurodectomy in tuberculosis patients. Method From January 2021 to May 2022, 60 patients who plan to undergo pleural exfoliation surgery with tuberculosis were enrlled as the research subjects, and they were randomly divided into the group S and the group C equally. Group S accepted the goal-directed fluid therapy, and the transfusion speed was adjusted according to the Stroke volume variation(SVV). Group C accepted the traditional liquid treatment, which according to the mean arterial pressure(MAP), central venous pressure, urinary production and other parameters. Radiographic assessment of lung edema (rale scoring) was used to evaluate the patients' pulmonary disease before operation, on the first day after operation, and on the third day after operation. Mean arterial pressure (MAP), heart rate (HR),pulse oxygen saturation(SPO₂) and peak airway pressure (PEAK)were recorded at five moment（T1, 5minutes before anesthesia; T2, 5minutes after tracheal intubation; T3, Beginning of the surgery; T4, Surgery was started for 1 hour; T5, the end of surgery）, the occurrence of postoperative complications also were recorded; The postoperative recovery quality score (The QoR-15) was performed on patients 1 day before surgery, the first postoperative day, and the third postoperative day to evaluate their postoperative recovery. Result Compared with group C, the rale score in group S was lower on the first postoperative day (P<0.05), and there was no significant difference in rale scores between the two groups on the third postoperative day; There was no statistically significant difference in intraoperative vital signs between the two groups; The infusion volume in group S was lower than group C (P<0.01); There was no significant difference in extubation time, postoperative hospital stay, urinary production and QoR-15 score. Conclusion GDFT can mitigate postoperative acute pulmonary edema and maintain stable circulation while reducing the infusion volume in TB patients.

Key words: Goal directed fluid therapy, Capacity management, Tuberculous pleurisy, Pleural exfoliation surgery, Stroke volume variation

CLC Number:

R614
R52

Zhong Xiangpeng, Liu Yong, Liu Qian, Liu Weiting, Liu Minqiang, He Renliang, WuQiang. Evaluation of efficacy of goal directed fluid therapy in pleural exfoliation surgery of tuberculosis patients under enhanced recovery after surgery mode[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(4): 25-29.

References

[1] ANTONANGELO L, FARIA CS, SALES RK.Tuberculous pleural effusion:diagnosis&management[J]. Expert Rev Respir Med, 2019, 13(8):747-759.
[2] LI M, PENG M.Prospective comparison of the effects of intraoperative goal-directed fluid therapy and restrictive fluid therapy on complications in thoracoscopic lobectomy[J]. J Int Med Res, 2021, 49(12):3000605211062787.
[3] WEINBERG L, MACKLEY L, HO A, et al.Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy:a single centre retrospective observational study[J]. BMC Anesthesiol, 2019, 19(1):135.
[4] BATCHELOR TJP, RASBURN NJ, ABDELNOUR-BERCHTOLD E, et al.Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)[J]. Eur J Cardiothorac Surg, 2019, 55(1):91-115.
[5] YAN YC, HAO WH, BAI FS, et al.Clinical Outcome Discrimination in Pediatric ARDS by Chest Radiograph Severity Scoring[J]. Can Respir J. 2022, 2022:9309611.
[6] VOIGT I, MIGHALI M, MANDA D, et al.Radiographic assessment of lung edema (RALE) score is associated with clinical outcomes in patients with refractory cardiogenic shock and refractory cardiac arrest after percutaneous implantation of extracorporeal life support[J]. Intern Emerg Med, 2022, 17(5):1463-1470
[7] SIKANDER N, AHMAD T, MAZCURI M, et al.Role of Anti-Tuberculous Treatment in the Outcome of Decortication for Chronic Tuberculous Empyema[J]. Cureus, 2021, 13(1):e12583.
[8] IQBAL MUHAMMAD A, GAVIN J, WILKINSON A.Indwelling pleural catheter for outpatient management of tuberculous empyema[J]. BMJ Case Rep, 2020, 13(3):e233213.
[9] BERGMANN A, BREITLING C, HEDENSTIERNA G, et al.Data on the effects of remote ischemic preconditioning in the lungs after one lung ventilation[J]. Data Brief, 2018,21:441-448.
[10] NEMOYER RE, PANTIN E, AISER J, et al.Paravertebral nerve block with liposomal bupivacaine for pain control following video-assisted thoracoscopic surgery and thoracotomy[J]. J Surg Res, 2020, 12(246):19-25.
[11] MOGAHED MM, ELKAHWAGY MS.Paravertebral block versus intercostal nerve block in non-intubated uniportal video-assisted thoracoscopic surgery:a randomised controlled trial[J]. Heart Lung Circ, 2020, 29(5):800-807.
[12] MALBRAIN M, LANGER T, ANNANE D, et al.Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy ( IFA )[J]. Ann Intensive Care, 2020, 10(1):64.
[13] 丁妮,张冬梅,高玉华,等.每搏量变异度指导的目标导向液体治疗对胃肠肿瘤患者术中、术后胃肠功能的影响[J]. 临床麻醉学杂志,2018,34(1): 45-49.
[14] 喻娟, 徐芬兰. FloTrac-Vigileo系统的应用对结核性毁损肺全肺切除术麻醉管理的影响[J/CD].新发传染病电子杂志, 2023, 8(2):18-22.
[15] 王冲, 杨磊, 闫东杰, 等. 结核性胸膜炎继发包裹性脓胸手术时机探讨[J].中华胸心血管外科杂志, 2018, 34(5):281-283.
[16] MESSINA A, MONTAGNINI C, CAMMAROTA G, et al.Tidal volume challenge to predict fluid responsiveness in the operating room: An observational study[J]. Eur J Anaesthesiol, 2019, 36(8):583-591.
[17] YANG SH, LIN YS, LEE CN, et al.Implications of continuous noninvasive finger cuff arterial pressure device use during cesarean delivery for goal-directed fluid therapy preload optimization:A randomized controlled trial[J]. Biomed Res Int, 2021, 28(2021):6685584.
[18] TANG A, ZHOU S.Analysis on the application value of goal-directed fluid therapy in patients undergoing laparoscopy-assisted radical gastrectomy with fasttrack anesthesia[J]. Am J Transl Res, 2021, 13(5):5174-5182.