Liver Surgery Clinical Trial
Official title:
Impact of Goal-directed Versus Restrictive Fluid Therapy on Urethral Tissue Perfusion in Hepatobiliary Surgery: A Prospective Randomized Controlled Trial
"Restrictive" fluid management is usually the current standard practice for patients
undergoing liver surgery. The general idea is to maintain a low central venous pressure in
order to decrease blood loss and improve the quality of the surgical field. However, this
strategy , considered as rather "restrictive", can be associated with patient's harm, mainly
acute kidney injury.
Today, Goal directed fluid therapy (GDFT) is a well accepted strategy to optimize fluid
administration in patients undergoing major surgery which aimed to maintain normovolemia
without being too liberal.
The goal of this randomized controlled trial is to compare these two strategies on Urethral
Perfusion index measured with a new IKORUS UP probe (Foley catheter made smarter with
embedded photoplethysmographic sensing technology).
Restrictive fluid administration aiming at maintaining a low central venous pressure
(low-CVP) during liver surgery has always been considered as a "gold standard" strategy
because it decrease blood loss and improve the quality of the surgical field. However, this
strategy , rather "restrictive", can be associated with patient harm (mainly AKI).
Today, Goal directed fluid therapy (GDFT) is a well accepted strategy to optimize fluid
administration in patients undergoing major surgery.Some studies have shown that this
strategy is feasible for such patient population.
There is currently a lack of data supporting the advantage of one strategy over the other in
this patient population.While a restrictive fluid strategy can advantage the surgeon, it can
also disadvantage the patient as in order to avoid hypotension, vasopressors administration
is required. If the patient is hypovolemic, such strategy may cause acute kidney injury.
The goal of this randomized controlled trial is to compare these two strategies on Urethral
Perfusion index measured with a new Foley catheter with embedded photoplethysmographic
sensing technology). This new technology allows for continuous and easy monitoring of
urethral tissue perfusion
The investigators hypothesis is that patients in the GDFT group will have better Urethral
Perfusion index (uPI) during surgery (via a better cardiac blood flow optimization) compared
to patients in the restrictive (low CVP) group.
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