Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Anaesthesia

Perioperative fluid management is essential to the practice of anesthesia. Outcomes may be improved if fluid therapy is individualized according to the patient's fluid responsiveness. PiCCO is an invasive device that quantifies several parameters, including cardiac output (CO), stroke volume variation (SVV) and extravascular lung water (EVLW). Trans esophageal doppler monitoring (TED) is another minimally invasive form and has the benefit of providing beat to beat analysis. We designed this prospective, randomized study to evaluate the use of PiCCO monitor from the fluid and hemodynamic point of view in comparison to TED monitor in order to maintain an adequate circulatory volume ensuring end-organ perfusion and oxygen delivery. After research ethics{u2019} committee approval and patients{u2019} written informed consents, this study was performed on 72 patients of either sex (ASA I-II), undergoing major abdominal surgery. Patients were randomly allocated into two groups; PiCCO group (n = 36): where fluid management was guided by SVV, where colloid boluses were given to maintain SVV below 10% and TED group (n = 36): where fluid management where guided by (systolic flow time corrected for heart rate) (FTc). Colloid was infused when the (FTc) {u02C2} 0.35 second, the fluid challenge would be repeated until FTc raised {u02C3} 0.40 second with no change in SV. The laboratory parameters of organ hypoperfusion in perioperative period were recorded as well as the number of infectious and organ complications in the postoperative period

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