Effects of goal-directed fluid therapy on postoperative orthostatic intolerance in elderly patients

Objective To investigate the effects of stroke volume variation (SVV) guided goal-directed fluid therapy on the postoperative orthostatic intolerance (OI) in elderly patients after gastrointestinal surgery. Methods A total of 60 patients who were scheduled to undergo gastrointestinal surgery were randomly divided into two groups (n=30): a goal directed fluid therapy (Group G) and a conventional fluid therapy (Group C). For Group G, the FloTrac/Vigileo system was used to monitor cardiac index (CI) and stroke volume variation (SVV), where CI was maintained at 2.5-4.0 L·min-1·m-2, SVV at 8％-13％ and mean arterial pressure (MAP) at 60-100 mmHg. For Group C, MAP was maintained at 60-100 mmHg, while central venous pressure (CVP) at 8-12 cmH2O. The incidence of OI was recorded before surgery and 24, 48 and 72 h after surgery. Meanwhile, the hemodynamic responses of OI test were observed. The volume of crystalloid and colloid fluid used during surgery, the volume of blood loss, urinary volume, the duration of surgery, fluid intake and outtake 24 h after surgery, the time of anal first exhaust, hospitalization stay and postoperative complications were also recorded. Results There were 12 patients (40%) in Group G and 20 patients (66.7%) in Group C with OI 24 h after extubation (P<0.05). Compared with Group C, the volume of colloid fluid used was increased but the volumes of crystalloid and urinary volume 24 h after surgery were decreased in Group G. Group G reported an earlier time of anal first exhaust than Group C (P<0.05). Conclusions SVV-based goal-directed fluid therapy can reduce the incidence of OI, and facilitate early postoperative mobilization and the recovery of gastrointestinal function.