Early Goal-Directed Therapy Using FloTrac/EV1000 Platform for Hemodynamic Optimization to Improve Perioperative Outcomes in Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial

Abstract

Objective: To compare the efficacy of early goal-directed therapy (EGDT) based on the FloTrac/EV1000 platform versus standard care to improve perioperative outcomes in patients undergoing major abdominal surgery. Materials and Methods: Forty patients undergoing major abdominal surgery were randomized to the Control or EGDT group. The Control group was managed to achieve a mean arterial pressure (MAP) of 65 to 90 mmHg, a central venous pressure of 8 to 12 mmHg, a urine output of 0.5 mL/kg/h or more, and an SpO₂ of more than 95%. The EGDT group was managed to achieve similar goals using information from the FloTrac/ EV1000 platform by receiving fluid to maintain stroke volume variation (SVV) of less than 13%, inotropic drugs to achieve a cardiac index (CI) of 2.2 to 4.0 L/min/m⁻², and/or vasoactive drugs to achieve a systemic vascular resistance index (SVRI) of 1,600 to 2,500 dynes·s/cm⁻⁵/m². Results: There were 20 patients in each group. The EGDT group received more colloid (p=0.035). The MAP and SVRI of both groups were comparable. The SVV of the Control group was higher (p=0.002), while the CI of the EGDT group was higher (p<0.001). The EGDT group had a shorter intubated time and a shorter stay in the ICU, with a mean difference of –3.95 h (95% CI –7.85 to –0.05, p=0.047) and –14.75 h (95% CI –25.38 to –4.12, p=0.008), respectively. The EGDT group had shorter hospital stays, albeit without significance (p=0.273). No postoperative complication was detected. Conclusion: Implementation of EGDT using FloTrac/EV1000, compared to conventional care, in patients undergoing major abdominal surgery results in shorter intubated time and shorter stay in the ICU. The shorter hospital stay did not achieve statistical significance. Keywords: Early goal-directed therapy; Major abdominal surgery; Perioperative outcome; Intubation time; ICU stay; Hospital stay