الفهرس 
Acknowledgement
Techniques for Goal-Directed FluidManagementOnly 14 pages are availabe for public view
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Abstract
Intraoperative fluid replacement is a challenging issue in surgical care. The optimal strategy for fluid management during colorectal surgery remains unclear. The aim of the study is to compare the effect of two different protocol of fluid therapy in patients undergoing elective colorectal surgery under general anesthesia regarding hemodynamics and kidney function outcomes.
This randomized controlled clinical trial was carried out in assiut university hospitals in general surgery operative theatre, and postoperative icu between march 2017 and may 2018.
Sixty patients were divided into 2 groups 30 patients in each group according to the strategy of intraoperative fluid management used: restrictive fluid strategy 6 mL/kg/h of crystalloid were perfused (group R) and conservative fluid strategy12 mL/kg/h of crystalloid were perfused. In both groups, a fluid bolus was administered when PVI value of >14%.
Primary outcome: the condition of acute kidney injury was determined by KDIGO classification and renal biomarker NGAL (Serum level more than 149 ng/ml diagnosed as AKI). Secondary outcomes:Intraoperative hypovolemia detected by pleth variability index (PVI), Intraoperative hemodynamic variables which include: heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure, Intraoperative fluid balance which include crystalloid perfused, estimated blood loss and urine output.
The main finding of this study is that intraoperative fluid restriction, using goal directed therapy guided by PVI increased the incidence of AKI according to KDIGO classification, but with the use of NGAL as renal biomarker for detection of renal injury there was no significant difference between both groups in the incidence of AKI.
Three cases of hypovolemia were detected with PVI, all of them were in restrictive group with no significant difference in the incidence of hypovolemia between both groups.
Intra- and 24 hour postoperative fluid balance were significantly higher in conservative group compared to restrictive group. Total intra- and 24 hour postoperative fluid intake (which include crystalloids, plasma and packed RBCs) were significantly higher in conservative group compared to restrictive group, total outputs (which include urine output, drains and nasogastric tube) during intra- and 24 hour postoperative period were significantly higher in conservative group compared to restrictive group. The incidence of complications did not differ significantly between both groups. Restrictive group associated with significant decrease in the duration of hospital stay.