Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial

Duo Duo Wang; Yun Li; Xian Wen Hu; Mu Chun Zhang; Xing Mei Xu; Jia Tang

doi:10.1186/s13741-021-00220-5

Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial

Perioper Med (Lond). 2021 Dec 15;10(1):48. doi: 10.1186/s13741-021-00220-5.

Authors

Duo Duo Wang^{1

2}, Yun Li^{1

2}, Xian Wen Hu^{3

4}, Mu Chun Zhang^{1

2}, Xing Mei Xu^{1

2}, Jia Tang^{1

2}

Affiliations

¹ Department of Anesthesiology, The Second Hospital of Anhui Medical University, 678 Furong Road, Economic Development Zone, Hefei City, 230032, Anhui Province, China.
² Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei city, 230032, Anhui, China.
³ Department of Anesthesiology, The Second Hospital of Anhui Medical University, 678 Furong Road, Economic Development Zone, Hefei City, 230032, Anhui Province, China. huxianwen001@163.com.
⁴ Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei city, 230032, Anhui, China. huxianwen001@163.com.

Abstract

Background: Postoperative delirium (POD) is a common phenomenon after spinal surgery. Intraoperative fluid management may affect POD. The aim of this study was to compare the effects of restrictive fluid therapy (RF) with those of goal-directed fluid therapy (GDT) on POD.

Methods: A total of 195 patients aged ≥ 50 years who underwent spinal surgery were randomly divided into two groups: the RF group and the GDT group. In group RF, a bolus of lactated Ringer's solution was administered at a dose of 5 mL·kg^-1 before the induction of anesthesia, followed by a dose of 5 mL·kg^-1·h^-1 until the end of surgery. For patients in the GDT group, in addition to the initial administration of lactated Ringer's solution at 5 mL·kg^-1, the subsequent fluid therapy was adjusted by using a continuous noninvasive arterial pressure (CNAP) monitoring system to maintain pulse pressure variation (PPV) ≤ 14%. The primary endpoint was the incidence of POD, assessed once daily with the Confusion Assessment Method-Chinese Reversion (CAM-CR) scale at 1-3 days postoperatively. The secondary endpoints were intraoperative fluid infusion volume, urine volume, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), regional cerebral oxygen saturation (rSO₂) value, lactic acid value, and visual analog scale (VAS) pain score at 1-3 days after surgery. Moreover, postoperative complications and the length of hospital stay were recorded.

Results: The incidence of POD was lower in the GDT group than in the RF group (12.4% vs 4.1%; P = 0.035) in the first 3 days after spine surgery. Compared to group RF, group GDT exhibited a significantly increased volume of intraoperative lactated Ringer's solution [1500 (interquartile range: 1128 to 1775) mL vs 1000 (interquartile range: 765 to 1300) mL, P < 0.001] and urine volume [398 (interquartile range: 288 to 600) mL vs 300 (interquartile range: 200 to 530) mL, P = 0.012]. Intraoperative MAP, CI and rSO₂ values were higher in the GDT group than in the RF group (P < 0.05). Moreover, the length of hospital stay [17.0 (14 to 20) days versus 14.5 (13 to 17.0) days, P = 0.001] was shorter in the GDT group than in the RF group.

Conclusions: GDT reduced the incidence of POD in middle- and old-aged patients undergoing spinal surgery possibly by stabilizing perioperative hemodynamic and improving the supply and demand of oxygen.

Trial registration: ChiCTR2000032603 ; Registered on May 3, 2020.

Keywords: Goal-directed fluid therapy; Postoperative delirium; Restrictive fluid therapy; Spinal surgery.