Influence of Postoperative Fluid Management on Pulmonary Function after Esophagectomy

• Published in: Acta chirurgica belgica Vol. 113; no. 6; pp. 415 - 422
• Main Authors: Haase, O., Raué, W., Neuss, H., Koplin, G., Mielitz, U., Schwenk, W.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-11-2013
• Subjects: Aged; Blood Volume; Esophageal Neoplasms - physiopathology; Esophageal Neoplasms - surgery; Esophagectomy; Female; Fluid Therapy - methods; Humans; Lung - physiopathology; Male; Middle Aged; Postoperative Care; Postoperative Period; Respiratory Function Tests
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2013.11680956

Purpose : The aim of this study was to investigate the effects of a restrictive vs. a liberal postoperative fluid therapy guided by intrathoracic blood volume index (ITBVI) on hemodynamic and pulmonary function in patients undergoing elective esophagectomy. Perioperative fluid therapy may influence postoperative physiology and morbidity after esophageal surgery. Definitions of adequate infusion amounts and evident rules for a fluid therapy are missing. Methods : After esophagectomy, 22 patients were randomized either to a restrictive group (RG) with low range of ITBVI (600-800 ml/m
2
) or a liberal group (LG) with normal ITBVI (800-1000 ml/m
2
). Infusion regimen was modified twice a day according to transpulmonary thermodilution measurements until the 5th postoperative day. Primary endpoint was paO
2
/FIO
2
-ratio. Secondary endpoints were pulmonary function, fluid balance and hemodynamic as well as morbidity. Results : Demographic and surgical details did not differ between both groups. The calculated sample size was not reached. There were no postoperative differences in paO
2
/FIO
2
-ratio, ITBVI, hemodynamic parameters, or morbidity either. Cumulative fluid uptake was 4.1 liter less in the RG on the 5th postoperative day (p = 0.01), and pulmonary function was better in these patients (area under curve day 2-7 for forced vital capacity (FVC), forced expiratory volume in one second (FEV'), peak expiratory flow (PEF) each < 0.05).
Conclusion : ITBVI guided restrictive infusion therapy yields a lower fluid uptake, but may not result in a difference of clinical relevant parameters. A fluid restriction after esophagectomy should always be combined with hemodynamic monitoring because additional infusions may be required.