Dynamic parameters predict fluid responsiveness and improve fluid management during surgery. We intend to demonstrate that the noninvasive pleth variability index (PVI) guides peroperative fluid management and optimizes the circulatory status.

Patients scheduled for major abdominal surgery were randomized into two groups comparing the peroperative PVI-directed fluid management (group P) versus standard care (control, group C). Protocol: induction of general anesthesia was followed by, in group P, 500 ml followed by 2 ml/kg/hour crystalloids; 250 ml colloids infused if PVI >13% for more than 5 minutes; if required, vasoactive support was introduced after lowering PVI <10%. In group C, 500 ml crystalloids followed by fluids at the discretion of the anesthesiologist.

Eighty-two patients completed the protocol. No difference was detected in preoperative characteristics, type of surgery and anesthesia. Peroperative and postoperative (24-hour) crystalloid infusions were significantly different. Lactate levels were significantly lower in group P, whereas the peroperative and postoperative volumes infused in group P were lower (Figure 1).