Goal-directed fluid therapy in craniotomy surgery: a prospective, randomized controlled trial


Craniotomy ; Pulse wave analysis ; Stroke volume variation ; Cardiac index; intraoperative blood pressure management ; Intraoperative goal-directed fluid management ; Arterial pressure waveform analysis

Published online: Mar 29 2019


L.V. Mitrev (*), J.S. Sehdev (*), A.R. Turtz (**), K.C.Trivedi (*), M.M. Misbin (*), M.C. Torjman (*,***), M.S. Muntazar (*,****), J.P. Gaughan (*****), E. Bojaxhi (******)

(*) Dpt of Anesthesiology, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, U.S.A.
(**) Dpt of Neurosurgery, Cooper University Hospital, Camden, NJ 08103, U.S.A.
(***) Anesthesiology Program For Translational Research, Thomas Jefferson University, Philadelphia, PA 19107, U.S.A.
(****) Dpt of Anesthesiology, Deborah Heart and Lung Center, Browns Mills, NJ 08015, U.S.A.
(*****) Cooper Research Institute, Camden, NJ 08103, U.S.A.
(******) Dpt of Anesthesiology, Mayo Clinic, Jacksonville, FL, U.S.A.


We studied the use of goal directed fluid therapy (GDFT) in a population of patients undergoing elective craniotomy surgery for intracranial lesion (cerebral tumor, metastasis or abscess), epilepsy surgery, or Chiari I malformation. The study was a prospective, single-blinded, randomized controlled trial. Fifty-six (56) ASA Class I to IV patients were enrolled. The subjects were randomized into one of two groups: a control group, and an intervention group where a GDFT algorithm was used. In order to evaluate the effectiveness of GDFT, data analysis was focused on patients who experienced hypotension to pre-defined parameters. In these patients, the mean intraoperative fluid administered in the GDFT group was less than in the control group; however, there was no statistical difference [2766 ± 1134 mL vs. 4238 ± 2915 mL, respectively (mean ± SD), p = 0.152]. Mean ICU length of stay in the GDFT group was longer, but the difference was not statistically significant (5 ± 13 days vs. 2.5 ± 2 days, respectively, p = 0.256). There were no differences in the length of hospital stay, evidence of under-resuscitation, or neurological complications for 30 days after the surgery. We conclude that GDFT in elective craniotomies does not lead to a significant reduction in intraoperative fluid administration or improved perioperative outcomes.