Comparison of Pulse Pressure Variation and Central Venous Pressure for Fluid Management Guidance in Intracranial Tumor Surgery

Detailed Summary

This study investigates the efficacy of pulse pressure variation (PPV) compared to central venous pressure (CVP) in guiding fluid management during intracranial tumor surgeries. Perioperative fluid therapy is critical to prevent complications arising from both hypovolemia (e.g., hypotension, tissue hypoperfusion, ischemia) and hypervolemia (e.g., pulmonary edema, delayed wound healing, infection). Traditional fluid therapy relies on static parameters such as CVP, which have limited sensitivity and specificity. Emerging technologies and dynamic parameters, including PPV and stroke volume variation (SVV), offer higher accuracy in evaluating fluid responsiveness. This randomized study includes 42 patients, aged 18-65 years, undergoing elective intracranial tumor surgery under general anesthesia. Patients are classified as ASA I-III and are randomized into two groups: 1. Group N: Fluid therapy guided by PPV. 2. Group S: Fluid therapy guided by CVP. The study follows standard perioperative protocols, with PPV (\>13%) and CVP (0-6 mmHg) used as primary parameters for fluid administration. Key outcomes include intraoperative fluid requirements (primary) and secondary parameters such as serum lactate levels, incidence of hypotension, brain relaxation scores, and ICU length of stay. PPV has been shown to be more reliable than CVP in predicting fluid responsiveness, particularly in mechanically ventilated patients with tidal volumes ≥8 mL/kg. However, its efficacy in neurosurgical patients remains underexplored. This study aims to determine if PPV can replace CVP as a superior guide for fluid therapy, enhancing patient outcomes and minimizing complications.

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