Background
Although aggressive fluid hydration prevents a decrease in renal cortical perfusion
(RCP) during laparoscopic donor nephrectomy, excess fluid is deleterious. We assessed
whether goal-directed fluid administration, based on hemodynamic measures, would maintain
RCP during pneumoperitoneum with less fluid loading.
Methods
In a pilot study of 7 pigs, goal-directed fluid administration was guided by monitoring
of stroke volume (SV) by esophageal Doppler measurement. During 15 mmHg CO2 pneumoperitoneum, a bolus of 5 mL/kg 0.9% NaCl was given when SV decreased to 90%
of baseline. Next, 18 pigs were randomized into 3 groups: low fluid (5 mL/kg per hour),
high fluid (25 mL/kg per hour) and goal directed. Urine output, heart rate, mean arterial
pressure, cardiac output, SV, and RCP were recorded every 15 minutes.
Results
Pilot data revealed mean RCP (mL/min per 100 g) was maintained (40 vs 39) during pneumoperitoneum
using goal-directed therapy. In the randomized study, RCP was decreased in the low
fluid group (43 vs 29; P= .02), but maintained in the high (46 vs 40) and goal-directed
(42 vs 39) groups. Mean fluid administered in the goal-directed group during pneumoperitoneum
was 10 mL/kg and only 3 of 6 of pigs required boluses. Urine output was decreased
in all 3 groups.
Conclusion
A goal-directed strategy during pneumoperitoneum allows for tailored fluid administration
and maintains RCP with lower volumes of intravenous fluid.
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Article info
Publication history
Accepted:
February 17,
2007
Footnotes
Supported by an educational grant from Tyco Healthcare Canada.
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
