Discussion
postoperative ileus, Postoperative GI disorder, Hypovolemia, SVV, POI, GI disorder, necrosis
BLIND, NECROSIS
This study found that using intraoperative GDFT guided by SVV and CI measured by the FloTrac/Vigileo monitor led to improved GI function and a shorter length of stay after major abdominal surgery.The GDFT group had a mean hospital stay of 9 days, which was 3 days shorter than the control group’s average stay of 12 days. This reduction in postoperative stay is comparable in size to findings from other studies [The recovery of GI function is a crucial factor in postoperative recovery following major abdominal surgery. Hypovolemia can cause loss of perfusion to the tip of the microvillus, triggering apoptosis and potentially necrosis, which typically requires about 3 days for recovery [Postoperative GI disorder was commonly referred to as postoperative ileus (POI). However, the heterogeneous definition of POI precludes the ability to ascertain the true incidence of the condition and study it properly within a research setting. In 2018, the American Society for Enhanced Recovery After Surgery (ERAS) and Perioperative Joint Consensus considered forgoing the traditional definition of POI for I-FEED scoring system, a more functional definition of POGD, to precisely describe the clinical manifestations of the GI disorder [Our study found that SVV-guided GDFT resulted in a significant reduction in total fluid administered (by 29%) and crystalloid administration (by 27%). This suggests that the beneficial effect of GDFT on the recovery of GI function can be attributed to the responsive and guided use of fluids, as well as the avoidance of unnecessary and potentially harmful fluid delivery when hemodynamic goals were met. Additionally, prior research has identified an independent effect of intraoperative volume on postoperative recovery of GI function [When interpreting these results, it is important to keep the limitations in mind. First, this trial included a mixture of major abdominal oncologic procedures which may potentially influence our results because different types of abdominal surgery led to different mechanical or manipulation forces on the gut and its mesentery. The two groups in this study were comparable with respect to surgical technique, type of procedure and operative POSSUM score. Second, although the data were collected by independent dedicated research personnel not involved in the intraoperative management of patients, we were unable to blind the anesthesiologists and investigators in operating room as to the treatment group, and hence may have introduced bias. However, intraoperative fluid administration in both groups was guided by specific fluid administration protocols, which should minimize bias. Third, the optimal cut-off value for SVV is still uncertain, results of protocols based only on variations itself should be assessed with caution. We used the 12% threshold in our study recommend by Ramsingh [In summary, our study found that using GDFT guided by SVV and CI with the FloTrac/Vigileo monitor resulted in faster recovery of GI function and shorter hospital stays in low-to-moderate risk patients undergoing major abdominal surgery. However, further large-scale studies are necessary to fully evaluate the impact of this strategy on morbidity and mortality.