Efficacy and Safety of Stroke Volume Variation-Guided Fluid Therapy for Reducing Blood Loss and Transfusion Requirements During Radical Cystectomy: A Randomized Clinical Trial

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2016 May 14

PMID 27175706

Citations 3

Authors

Yu-Gyeong Kong

Ji Yoon Kim

Jihion Yu

Jinwook Lim

Jai-Hyun Hwang

Young-Kug Kim

Affiliations

Soon will be listed here.

Abstract

Radical cystectomy, which is performed to treat muscle-invasive bladder tumors, is among the most difficult urological surgical procedures and puts patients at risk of intraoperative blood loss and transfusion. Fluid management via stroke volume variation (SVV) is associated with reduced intraoperative blood loss. Therefore, we evaluated the efficacy and safety of SVV-guided fluid therapy for reducing blood loss and transfusion requirements in patients undergoing radical cystectomy.This study included 48 patients who underwent radical cystectomy, and these patients were randomly allocated to the control group and maintained at <10% SVV (n = 24) or allocated to the trial group and maintained at 10% to 20% SVV (n = 24). The primary endpoints were comparisons of the amounts of intraoperative blood loss and transfused red blood cells (RBCs) between the control and trial groups during radical cystectomy. Intraoperative blood loss was evaluated through the estimated blood loss and estimated red cell mass loss. The secondary endpoints were comparisons of the postoperative outcomes between groups.A total of 46 patients were included in the final analysis: 23 patients in the control group and 23 patients in the trial group. The SVV values in the trial group were significantly higher than in the control group. Estimated blood loss, estimated red cell mass loss, and RBC transfusion requirements in the trial group were significantly lower than in the control group (734.3 ± 321.5 mL vs 1096.5 ± 623.9 mL, P = 0.019; 274.1 ± 207.8 mL vs 553.1 ± 298.7 mL, P <0.001; 0.5 ± 0.8 units vs 1.9 ± 2.2 units, P = 0.005). There were no significant differences in postoperative outcomes between the two groups.SVV-guided fluid therapy (SVV maintained at 10%-20%) can reduce blood loss and transfusion requirements in patients undergoing radical cystectomy without resulting in adverse outcomes. These findings provide useful information for optimal fluid management during radical cystectomy.

Citing Articles

Does the Administration of Intravenous Fluid Matter in the Context of the Incidence of Postoperative Complications After Radical Cystectomy?.

Lipowski P, Ostrowski A, Adamowicz J, Jasiewicz P, Kowalski F, Drewa T Cancers (Basel). 2025; 17(1.

PMID: 39796730 PMC: 11720066. DOI: 10.3390/cancers17010102.

Perioperative outcomes of goal-directed versus conventional fluid therapy in radical cystectomy with enhanced recovery protocol.

Ghoreifi A, Basin M, Ghodoussipour S, Bazargani S, Amini E, Aslzare M Int Urol Nephrol. 2021; 53(9):1827-1833.

PMID: 34089170 DOI: 10.1007/s11255-021-02903-w.

Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis.

Yu J, Hong B, Park J, Lee Y, Hwang J, Kong Y J Clin Med. 2020; 9(7).

PMID: 32674456 PMC: 7408753. DOI: 10.3390/jcm9072236.

Efficacy and Safety of Stroke Volume Variation-Guided Fluid Therapy for Reducing Blood Loss and Transfusion Requirements During Radical Cystectomy: A Randomized Clinical Trial: Erratum.

Medicine (Baltimore). 2018; 97(23):e11129.

PMID: 29879080 PMC: 5999509. DOI: 10.1097/MD.0000000000011129.

References

Kwon T, Jeong I, Lee C, You D, Hong B, Hong J . Acute Kidney Injury After Radical Cystectomy for Bladder Cancer is Associated with Chronic Kidney Disease and Mortality. Ann Surg Oncol. 2015; 23(2):686-93. DOI: 10.1245/s10434-015-4886-4. View

Marik P, Cavallazzi R, Vasu T, Hirani A . Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009; 37(9):2642-7. DOI: 10.1097/CCM.0b013e3181a590da. View

Chang S, Smith Jr J, Wells N, Peterson M, Kovach B, Cookson M . Estimated blood loss and transfusion requirements of radical cystectomy. J Urol. 2001; 166(6):2151-4. View

Bang S, Ahn H, Kim G, Yang M, Gwak M, Ko J . Predictors of high intraoperative blood loss derived by simple and objective method in adult living donor liver transplantation. Transplant Proc. 2010; 42(10):4148-50. DOI: 10.1016/j.transproceed.2010.10.017. View

Cookson M, Chang S, Wells N, Parekh D, Smith Jr J . Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J Urol. 2002; 169(1):101-4. DOI: 10.1016/S0022-5347(05)64045-1. View

Kobayashi M, Koh M, Irinoda T, Meguro E, Hayakawa Y, Takagane A . Stroke volume variation as a predictor of intravascular volume depression and possible hypotension during the early postoperative period after esophagectomy. Ann Surg Oncol. 2009; 16(5):1371-7. DOI: 10.1245/s10434-008-0139-0. View

Forget P, Lois F, De Kock M . Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg. 2010; 111(4):910-4. DOI: 10.1213/ANE.0b013e3181eb624f. View

Mazo V, Sabate S, Canet J, Gallart L, de Abreu M, Belda J . Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014; 121(2):219-31. DOI: 10.1097/ALN.0000000000000334. View

Charron C, Fessenmeyer C, Cosson C, Mazoit J, Hebert J, Benhamou D . The influence of tidal volume on the dynamic variables of fluid responsiveness in critically ill patients. Anesth Analg. 2006; 102(5):1511-7. DOI: 10.1213/01.ane.0000209015.21418.f4. View

10.

Bennett-Guerrero E, Welsby I, Dunn T, Young L, Wahl T, Diers T . The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg. 1999; 89(2):514-9. DOI: 10.1097/00000539-199908000-00050. View

11.

Pillai P, McEleavy I, Gaughan M, Snowden C, Nesbitt I, Durkan G . A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol. 2011; 186(6):2201-6. DOI: 10.1016/j.juro.2011.07.093. View

12.

Joshi R, de Witt B, Mosier J . Optimizing oxygen delivery in the critically ill: the utility of lactate and central venous oxygen saturation (ScvO2) as a roadmap of resuscitation in shock. J Emerg Med. 2014; 47(4):493-500. DOI: 10.1016/j.jemermed.2014.06.016. View

13.

Choi S, Kim S, Kim Y . Fluid management in living donor hepatectomy: Recent issues and perspectives. World J Gastroenterol. 2015; 21(45):12757-66. PMC: 4671031. DOI: 10.3748/wjg.v21.i45.12757. View

14.

Valenza F, Aletti G, Fossali T, Chevallard G, Sacconi F, Irace M . Lactate as a marker of energy failure in critically ill patients: hypothesis. Crit Care. 2005; 9(6):588-93. PMC: 1414013. DOI: 10.1186/cc3818. View

15.

Meyer J, Blick C, Arumainayagam N, Hurley K, Gillatt D, Persad R . A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients. BJU Int. 2008; 103(5):680-3. DOI: 10.1111/j.1464-410X.2008.08204.x. View

16.

Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I . Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005; 103(1):25-32. DOI: 10.1097/00000542-200507000-00008. View

17.

Berrum-Svennung I, Hedelin H, Holmang S . Costs of radical cystectomy. Scand J Urol Nephrol. 2005; 39(1):36-41. DOI: 10.1080/00365590410002537. View

18.

Wuethrich P, Burkhard F, Thalmann G, Stueber F, Studer U . Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology. 2013; 120(2):365-77. DOI: 10.1097/ALN.0b013e3182a44440. View

19.

van Rhijn B, Burger M, Lotan Y, Solsona E, Stief C, Sylvester R . Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. 2009; 56(3):430-42. DOI: 10.1016/j.eururo.2009.06.028. View

20.

Pinsky M . Functional hemodynamic monitoring. Crit Care Clin. 2014; 31(1):89-111. PMC: 4250574. DOI: 10.1016/j.ccc.2014.08.005. View