Volume challenge pulse pressure variation(VtPPV)and effect of pulse pressure variation(PPV)on goal-directed fluid volume management strategies in elderly hip surgery
Objective To compare the effects of 2 fluid goal-oriented management methods,volume chal-lenge pulse pressure variation(VtPPV)and pulse pressure variation(PPV)on the infusion volume and prognosis of elderly hip surgery.Methods 100 patients who underwent elective hip surgery under general anesthesia in the hospital from September 2021 to August 2023 were selected as research subjects.The pa-tients were divided into tidal volume challenge PPV(VtP group)and PPV group(P group)using the ran-dom number table method,50 cases in each group.In VtP group,the tidal volume was increased from 6 mL/kg to 8 mL/kg for 1 min.If ΔPPV≥3.5%,200 mLcolloidalsolution was injected quickly with in 10 min.The measurement and intervention were repeatedwithin 1 min before the end of fluid preload.If the displayvolume was not good for two consecutive times,the second infusion of 200 mL crystal solution until ΔPPV<3.5%.In Pgroup,when the tidal volume was 8 mL/kg,if PPV≥11%persists for 1 minute,200 mL of colloidal solution was injected within 10 mins.The measurement and intervention were repeated with in 1 min before the end of fluid preload.If the displayvolume was not good for 2 consecutive times,the second infusion of 200 mL of crystal solution until the PPV<11%.Time weighted average of hypoten-sion(TWA),blood lactate level,transfusion volume,blood loss and urinewere recorded.Incidence of pul-monary and urinary complications 48 hafter surgery,length of hospital stayand QoR-15 satisfaction score 24 and 48 hafter surgery.The mean arterial pressure and heart rate were recorded athome,after intubation,during in-cision,and at different time points during the operation.Results Compared with P group,the the total infusion volume,crystal dosage and blood lactate level in VtP group after operation were reduced,the colloid dosage was increased,the mean arterial pressure was increasedat 60 and 90 mins at the beginning of operation,the intraopera-tive TWA was decreased,and the recovery satisfaction score at 24 hafter operation was increased,with statistical significance(P<0.05).Conclusion In elderly hip surgery,the target-oriented fluid volume management strategy based on tidal volume challenge PPV has lessincidence of perioperative hypotension,reduces intraoperative fluid in-fusion volume and improves patient satisfaction.