Intraoperative monitoring of stroke volume variation versus central venous pressure in liver surgery: a Meta-analysis of randomized clinical trials

Abstract

Abstract: Objective:To explore the best method of monitoring during hepatectomy by Meta-analysis.
Methods:From inception to December 13, 2022, The electronic databases of PubMed, Web of Science, Embase, CNKI and the Cochrane Library were searched. Randomized clinical trials reporting outcomes with comparison between stroke volume variation (SVV) guided goal-directed fluid therapy and low central venous pressure (LCVP) guided fluid therapy during liver surgery were included by inclusion and exclusion criteria. The perioperative data was statistically summarized using Review Manager 5.3 software.
Results:A total of 10 randomized clinical trials were included, with a total sample size of 702 cases, including 354 cases (50.4%) in SVV group and 348 cases (49.6%) in LCVP group. The results of Meta-analysis showed that the arterial lactate concentration in the SVV group was significantly lower than that in the LCVP group, with a statistically significant difference between the two groups (weighted mean difference =-0.84 mmol/L, 95%CI: -1.43 mmol/L to -0.25 mmol/L , P=0.005). The reduce intraoperative bleeding and the incidence of total complications without statistically significant differences(all P>0.05). There were no significant differences in surgical field, postoperative biochemical indexes, incidence of serious complications, incidence of postoperative acute renal injury, and length of hospital stay between the two groups(all P>0.05). Conclusion:The use of SVV directed fluid therapy in liver surgery is safe, does not lead to prolonged operative time, increased intraoperative bleeding, or decreased surgical field quality, and significantly reduces intraoperative lactate concentration in patients undergoing hepatectomy.

Key words: Hepatectomy, Stroke volume variation, Low central venous pressure, Goal-directed fluid therapy, Meta-analysis

Du Longde, Huang Xiaozhun, Xie Yunliang, Zhou Jianguo, Bi Xinyu, Che Xu, Ni Yong. Intraoperative monitoring of stroke volume variation versus central venous pressure in liver surgery: a Meta-analysis of randomized clinical trials[J]. Electronic Journal of Liver Tumor, 2023, 10(4): 29-37.

References

[1] CORREA-GALLEGO C, TAN K S, ARSLAN-CARLON V, et al.Goal-directed fluid therapy using stroke volume variation for resuscitation after low central venous pressure-assisted liver resection: a randomized clinical Trial[J]. J Am Coll Surg, 2015, 221(2): 591-601.
[2] HUGHES M J, MCNALLY S, WIGMORE S J.Enhanced recovery following liver surgery: a systematic review and meta-analysis[J]. HPB (Oxford), 2014, 16(8): 699-706.
[3] HUGHES M J, VENTHAM N T, HARRISON E M, et al.Central venous pressure and liver resection: a systematic review and meta-analysis[J]. HPB (Oxford), 2015, 17(10): 863-871.
[4] ONUIGBO M A, AGBASI N.Association of intraoperative hypotension with acute kidney injury after elective non-cardiac surgery-prevention is better than cure[J]. Ren Fail, 2016, 38(1): 168-169.
[5] MONK T G, BRONSERT M R, HENDERSON W G, et al.Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery[J]. Anesthesiology, 2015, 123(2): 307-319.
[6] MUNGROOP T H, GEERTS B F, VEELO D P, et al.Fluid and pain management in liver surgery (MILESTONE): a worldwide study among surgeons and anesthesiologists[J]. Surgery, 2019, 165(2): 337-344.
[7] BIANCOFIORE G, CRITCHLEY L A, LEE A, et al.Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery[J]. Br J Anaesth, 2009, 102(1): 47-54.
[8] SLAGT C, MALAGON I, GROENEVELD A B.Systematic review of uncalibrated arterial pressure waveform analysis to determine cardiac output and stroke volume variation[J]. Br J Anaesth, 2014, 112(4): 626-637.
[9] DUNKI-JACOBS E M, PHILIPS P, SCOGGINS C R, et al. Stroke volume variation in hepatic resection: a replacement for standard central venous pressure monitoring[J]. Ann Surg Oncol, 2014, 21(2): 473-478.
[10] CHONG M A, WANG Y, BERBENETZ N M, et al.Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?: a systematic review and meta-analysis[J]. Eur J Anaesthesiol, 2018, 35(7): 469-483.
[11] MOHER D, LIBERATI A, TETZLAFF J, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement[J]. Bmj, 2009, 339: b2535.
[12] HIGGINS J P, ALTMAN D G, GøTZSCHE P C, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011, 343: d5928.
[13] MEI X, LIU J, WANG Y, et al.Application of stroke volume variation-guided liquid therapy in laparoscopic precision hepatectomy[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2019, 44(10): 1163-1168.
[14] WEINBERG L, IANNO D, CHURILOV L, et al.Goal directed fluid therapy for major liver resection:a multicentre randomized controlled trial[J]. Ann Med Surg (Lond), 2019, 45: 45-53.
[15] JONGERIUS I M, MUNGROOP T H, UZ Z, et al.Goal-directed fluid therapy vs. low central venous pressure during major open liver resections (GALILEO): a surgeon- and patient-blinded randomized controlled trial[J]. HPB(Oxford), 2021, 23(10): 1578-1585.
[16] CHIRNOAGA D, COECKELENBERGH S, ICKX B, et al.Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery: a pilot randomised controlled trial[J]. Eur J Anaesthesiol, 2022, 39(4): 324-332.
[17] RATTI F, CIPRIANI F, REINEKE R, et al.Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial[J]. HPB (Oxford), 2016, 18(2): 136-144.
[18] LEE J, KIM W H, RYU H G, et al.Stroke volume variation-guided versus central venous pressure-guided low central venous pressure with milrinone during living donor hepatectomy: a randomized double-blinded clinical trial[J]. Anesth Analg, 2017, 125(2): 423-430.
[19] 洪毅, 叶建荣, 郑宏, 等. 每搏变异度与维持低中心静脉压对半肝切除术患者肝肾功能和出血量的影响[J]. 临床麻醉学杂志, 2013, 29(9): 844-846.
[20] 陈笑红, 翁汉钦, 韩琪. 每搏变异度与维持低中心静脉压对肝叶切除术患者血乳酸水平和术后肝肾功能的影响[J]. 江苏医药, 2017, 43(17): 1248-1251.
[21] 郭云飞, 李建玲, 牛彦艳, 等. 允许性高每搏量变异度在老年患者腹腔镜肝切除术中的应用[J]. 临床麻醉学杂志. 2022, 38(4): 351-355.
[22] CHEN Y J, ZHEN Z J, CHEN H W, et al.Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach[J]. Hepatobiliary Pancreat Dis Int, 2014, 13(5): 508-512.
[23] OTSUBO T.Control of the inflow and outflow system during liver resection[J]. J Hepatobiliary Pancreat Sci, 2012, 19(1): 15-18.
[24] MCGEE DC, GOULD MK.Preventing complications of central venous catheterization[J]. N Engl J Med, 2003, 348(12): 1123-1133.
[25] KUSMINSKY R E.Complications of central venous catheterization[J]. J Am Coll Surg, 2007, 204(4): 681-696.
[26] SCHEER B, PEREL A, PFEIFFER U J.Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine[J]. Crit Care, 2002, 6(3): 199-204.
[27] SAITO R, AMEMIYA H, HOSOMURA N, et al.Stroke volume variation monitoring to minimize blood loss in hepatocellular carcinoma resection[J]. Anticancer Res, 2021, 41(1): 409-415.
[28] VIBERT E, BOLESLAWSKI E, COSSE C, et al. Arterial lactate concentration at the end of an elective hepatectomy is an early predictor of the postoperative course and a potential surrogate of intraoperative events[J]. Ann Surg, 2015, 262(5): 787-792; discussion 792-783.
[29] LEMKE M, KARANICOLAS P J, HABASHI R, et al.Elevated lactate is independently associated with adverse outcomes following hepatectomy[J]. World J Surg, 2017, 41(12): 3180-3188.
[30] NIEDERWIESER T, BRAUNWARTH E, DASARI B V M, et al. Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure[J]. Br J Surg, 2021, 108(11): 1360-1370.
[31] GASPARI R, TEOFILI L, ARDITO F, et al.High arterial lactate levels after hepatic resection are associated with low oxygen delivery and predict severe postoperative complications[J]. Biomedicines, 2022, 10(5): 1108.
[32] 黄小准, 王春玲, 黄璋侃, 等. 全肝与半肝入流阻断技术在肝切除术中的临床应用评价[J/CD]. 肝癌电子杂志, 2021 (8) : 55-58.
[33] THACKER J K, MOUNTFORD W K, ERNST F R, et al.Perioperative fluid utilization variability and association with outcomes: considerations for enhanced recovery efforts in sample us surgical populations[J]. Ann Surg, 2016, 263(3): 502-510.
[34] SHIN C H, LONG D R, MCLEAN D, et al.Effects of intraoperative fluid management on postoperative outcomes: a hospital registry study[J]. Ann Surg, 2018, 267(6): 1084-1092.
[35] WANG F, SUN D, ZHANG N, et al.The efficacy and safety of controlled low central venous pressure for liver resection: a systematic review and meta-analysis[J]. Gland Surg, 2020, 9(2): 311-320.
[36] RIPOLLÉS-MELCHOR J, ESPINOSA Á, MARTíNEZ-HURTADO E, et al. Perioperative goal-directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis[J]. J Clin Anesth, 2016, 28: 105-115.
[37] PEARSE R M, HARRISON D A, MACDONALD N, et al.Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review[J]. JAMA, 2014, 311(21): 2181-2190.