Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial
<b>Background/Objectives</b>: The use of goal-directed fluid therapy (GDFT) guided by stroke volume (SV) variation during thoracic surgery, particularly with one-lung ventilation (OLV) and protective ventilation strategies, is not well established. This study aimed to determine whether m...
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2025-05-01
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| author | Man-Ling Wang Po-Ni Hsiao Hsao-Hsun Hsu Jin-Shing Chen Ya-Jung Cheng |
| author_facet | Man-Ling Wang Po-Ni Hsiao Hsao-Hsun Hsu Jin-Shing Chen Ya-Jung Cheng |
| author_sort | Man-Ling Wang |
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| description | <b>Background/Objectives</b>: The use of goal-directed fluid therapy (GDFT) guided by stroke volume (SV) variation during thoracic surgery, particularly with one-lung ventilation (OLV) and protective ventilation strategies, is not well established. This study aimed to determine whether maximizing stroke volume (SV) before initiating one-lung ventilation (OLV) reduces the incidence of intraoperative hypotension requiring vasoactive agents during video-assisted thoracoscopic surgery (VATS). <b>Methods</b>: Sixty patients undergoing VATS were randomly assigned to an SVM group (<i>n</i> = 30) or a control group (<i>n</i> = 30). The SVM group received 6% hydroxyethyl starch before OLV to achieve and maintain an SV increase of less than 10%. The control group received no active fluid therapy before OLV positioning. Both groups received Ringer’s lactate solution intraoperatively based on baseline (control) or maximized (SVM) SV goals. The primary outcome was the use of vasoactive agents for hypotension. <b>Results</b>: Patients in the SVM group received significantly less Ringer’s lactate solution than controls (4.2 ± 2.4 vs. 6.1 ± 2.8 mL/kg/h, <i>p</i> = 0.005). While fewer patients in the SVM group required vasoactive agents (20% vs. 40%), the difference was not statistically significant (<i>p</i> = 0.091). IL-6 levels were significantly lower during OLV in the SVM group. <b>Conclusions</b>: Pre-OLV SVM was associated with reduced intraoperative crystalloid administration and attenuation of inflammatory response, with a non-significant trend toward lower vasopressor use. These findings suggest a potential benefit of SVM in thoracic surgery, though larger multicenter trials are needed to confirm clinical efficacy. |
| format | Article |
| id | doaj-art-a7ab4cc6077f4edbb8fdba2922b10e7d |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-a7ab4cc6077f4edbb8fdba2922b10e7d2025-08-20T03:46:52ZengMDPI AGDiagnostics2075-44182025-05-011511140510.3390/diagnostics15111405Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled TrialMan-Ling Wang0Po-Ni Hsiao1Hsao-Hsun Hsu2Jin-Shing Chen3Ya-Jung Cheng4Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, TaiwanDepartment of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, TaiwanDepartment of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, TaiwanDepartment of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, TaiwanDepartment of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan<b>Background/Objectives</b>: The use of goal-directed fluid therapy (GDFT) guided by stroke volume (SV) variation during thoracic surgery, particularly with one-lung ventilation (OLV) and protective ventilation strategies, is not well established. This study aimed to determine whether maximizing stroke volume (SV) before initiating one-lung ventilation (OLV) reduces the incidence of intraoperative hypotension requiring vasoactive agents during video-assisted thoracoscopic surgery (VATS). <b>Methods</b>: Sixty patients undergoing VATS were randomly assigned to an SVM group (<i>n</i> = 30) or a control group (<i>n</i> = 30). The SVM group received 6% hydroxyethyl starch before OLV to achieve and maintain an SV increase of less than 10%. The control group received no active fluid therapy before OLV positioning. Both groups received Ringer’s lactate solution intraoperatively based on baseline (control) or maximized (SVM) SV goals. The primary outcome was the use of vasoactive agents for hypotension. <b>Results</b>: Patients in the SVM group received significantly less Ringer’s lactate solution than controls (4.2 ± 2.4 vs. 6.1 ± 2.8 mL/kg/h, <i>p</i> = 0.005). While fewer patients in the SVM group required vasoactive agents (20% vs. 40%), the difference was not statistically significant (<i>p</i> = 0.091). IL-6 levels were significantly lower during OLV in the SVM group. <b>Conclusions</b>: Pre-OLV SVM was associated with reduced intraoperative crystalloid administration and attenuation of inflammatory response, with a non-significant trend toward lower vasopressor use. These findings suggest a potential benefit of SVM in thoracic surgery, though larger multicenter trials are needed to confirm clinical efficacy.https://www.mdpi.com/2075-4418/15/11/1405fluid managementgoal-directed fluid therapy (GDFT)stroke volumethoracic surgeryone-lung ventilation |
| spellingShingle | Man-Ling Wang Po-Ni Hsiao Hsao-Hsun Hsu Jin-Shing Chen Ya-Jung Cheng Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial Diagnostics fluid management goal-directed fluid therapy (GDFT) stroke volume thoracic surgery one-lung ventilation |
| title | Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial |
| title_full | Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial |
| title_fullStr | Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial |
| title_full_unstemmed | Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial |
| title_short | Effects of Stroke Volume Maximization Before One-Lung Ventilation on Video-Assisted Thoracic Surgery: A Randomized Controlled Trial |
| title_sort | effects of stroke volume maximization before one lung ventilation on video assisted thoracic surgery a randomized controlled trial |
| topic | fluid management goal-directed fluid therapy (GDFT) stroke volume thoracic surgery one-lung ventilation |
| url | https://www.mdpi.com/2075-4418/15/11/1405 |
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