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To compare intraoperative goal directed fluid therapy by trans-oesophageal Doppler vis-à-vis FloTrac™ in patients undergoing living related renal transplantation-a prospective randomised controlled study

Indian J Anaesth. 2020 Sep;64(Suppl 4):S220-S226 doi: 10.4103/ija.IJA_605_20.
Abstract
BACKGROUND:

Optimal intra-operative fluid therapy in renal transplantation (RT) is essential to ensure adequate graft function while preventing fluid overload related complications. This RCT was to compare the intraoperative goal directed fluid therapy (GDFT) based either on corrected flow time (CFT), measured by trans oesophageal Doppler (TED) or on the stroke volume variation (SVV), by FloTrac in patients undergoing living donor RT.

METHODS:

This prospective, randomised controlled trial (RCT) was done on 60 end stage renal disease (ESRD) patients, American Society of Anaesthesiologists(ASA) grade III-IV, age 18 to 65 years of either sex, scheduled for living donor RT under general anaesthesia. They were randomly divided into two groups: TED group (n = 30) and FloTrac™ group (n = 30) and administered GDFT, based upon CFT (TED) and SVV (FloTrac™). The primary outcome was to compare the total fluid and number of fluid boluses administered intraoperatively, while the secondary outcomes were to compare any postoperative complications due to fluid overload and allograft function, assessed by serial serum creatinine levels up to 90 days postoperatively.

RESULTS:

The mean total intra-operative fluid [3991.67 ± 856.32 vs. 3543.33 ± 1131.35, P = 0.089] and the amount of fluid administered per kg body weight per hour [13.32 ± 4.67 vs. 11.82 ± 4.76, P = 0.222] were lesser in the FloTrac compared to TED group, though not statistically significant. However, the postoperative incidence of allograft dysfunction, including rejection (P = 0.743) and acute tubular necrosis (ATN) (P = 0.999), and other complications (P = 0.643) were comparable.

CONCLUSIONS:

Both TED and FloTrac devices can be used effectively to guide GDFT in RT, However, lesser total fluid was required in the FloTrac group, which may lead to a lesser number of fluid-related postoperative complications.

CET Conclusion
Reviewer: Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This small single-centre study investigated the use of two different types of goal-directed fluid therapy during living donor kidney transplantation. Recipients were randomised to use of trans-oesophageal doppler or FloTrac (stroke volume variation) to guide fluid management intraoperatively. No significant differences were found in fluid volume, operative complications or post-operative outcomes between the groups. Overall, the study is well designed and reported, although it is not entirely clear why block randomization was required and the protocol was registered retrospectively. The biggest risk is of type II error due to small sample size, but from the data presented here it appears that either method of fluid management can be used effectively.
Methodological quality
Jadad score 2
Allocation concealment YES
Data analysis PER PROTOCOL
Study Details
Aims: The aim of this study was to compare two types of intraoperative goal directed fluid therapy (GDFT) in patients undergoing living donor kidney transplantation: one based on corrected flow time (CFT), measured using trans oesophageal doppler (TED), and another based on stroke volume variation (SVV), assessed using FloTrac™ .
Interventions: Participants were randomised to either the TED group or the FloTrac™ group.
Participants: 60 patients undergoing living donor kidney transplantation.
Outcomes: The primary endpoints were the assessment of total fluid and number of fluid boluses administered intraoperatively. The secondary endpoints were the assessment of allograft function as well as any postoperative complications resulting from fluid overload.
Follow Up: 90 days
Metadata
Funding: No funding was received for this study
Publication type: Randomised Controlled Trial
Trial registration: CTRI/2017/07/009159
Organ: Kidney
Language: English
Author email: drsandeepsahu@yahoo.co.in
MeSH terms: Kidney Transplantation