# Personalizezed Hemodynamic Optimization Using Stroke Volume, Pulse Pressure Variation, and Continuous Cardiac Index in Major Liver Surgery: A Randomized Controlled Trial

## TL;DR

This study shows that personalized hemodynamic therapy during major liver surgery reduces blood loss and transfusion needs compared to standard care.

## Contribution

The novel use of stroke volume, pulse pressure variation, and continuous cardiac index to guide personalized fluid therapy in liver surgery.

## Key findings

- Patients in the GDHT group had significantly less blood loss compared to the control group.
- Fewer patients in the GDHT group required intraoperative transfusion.
- Total fluid volume administered was significantly lower in the GDHT group.

## Abstract

Background/Objectives: The aim of this study was to evaluate fluid administration and intraoperative bleeding of patients who had major hepatic resection. We used artery pulse contour analysis monitor (ProAQT™) and personalized hemodynamic target-guided therapy, in which the administration of fluid, inotropes and vasopressors is guided by stroke volume, pulse pressure variation (SVV, PPV) and continuous cardiac index (CI). Methods: This trial was a prospective, randomized, parallel-group in adults scheduled for major hepatic resection. Participants were randomly assigned in equal numbers to one of two groups: (1) a control group receiving conventional perioperative care, and (2) an intervention group managed with goal-directed hemodynamic therapy guided by radial artery pulse contour analysis. Results: 45 patients were randomized to the GDHT (n = 16) and control group (n = 19). Blood loss was significantly higher in the control group than in GDHT group (728.13 ± 618.59 versus 292.63 ± 274.06, p = 0.009). The number of patients receiving intraoperative transfusion was significantly higher in the first group (6 ± 16 versus 0 ± 19, p = 0.005). Total volume infused was significantly higher in control group (CG) than in GDHT group (GG) (2853.13 ± 1432.18 versus 1125.79 ± 751.2, p = 0.001). Conclusions: Personalized goal-directed therapy optimizes intraoperative fluid administration during major liver resection and reduces blood transfusion.