Clinical research on glucose dilution guided fluid volume management Outcome study

2007 Fiscal Year Final Research Report Summary

• Project/Area Number: 18591685
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Anesthesiology/Resuscitation studies
• Research Institution: Hirosaki University
• Principal Investigator: ISHIHARA Hironori Hirosaki University, Hirosaki University, Graduate School of Medicine, Associate Prof (50111224)
• Co-Investigator(Kenkyū-buntansha): TSUBO Toshihito Hirosaki University, University Hospital, Associate Prof (30133870) ; OKAWA Hirobumi Hirosaki University, Graduate School of Medicine, Lecturer (40322953)
• Project Period (FY): 2006 – 2007
• Keywords: fluid management / glucose / dilution / complication / prognosis / hypotension / fluid accumulation / intensive care

Research Abstract

We have proposed that initial distribution volume of glucose (IDVG) which can be determined simply and rapidly with glucose (5g) injection is an alternative marker of fluid management. The aim of this study was to compare conventional fluid management with routine cardiovascular monitoring (Group C) and IDVG guided fluid management (Group I) in ICU patients with special reference to length of ventilation and ICU stay as well as cardiovascular complications. Methods. A total 258 patients were studied, and divided randomly into two groups; 126 patients for Group C and 132 patients for Group I. IDVG was measured daily in Group I and used as a decision marker of fluid management. Considering number of studied patients in this study, statistical analysis was done only in patients after cardiovascular surgery (42 for C, 39 for I) and radical operation for esophageal cancer (13 for both). Results. In Group I no patient developed apparent deterioration of patient's condition requiring withhold glucose dilution guided management, whereas one patient in Group C with continued life threatening hypotension was changed to Group I. In both surgical procedures, there was no difference in length of ventilation, length of ICU stay, pulmonary oxygenation, and incidence of atrial fibrillation and acute renal failure between two groups. Body weight on ICU discharge day of Group I after cardiovascular surgery was lower than that of Group I by an average of 2.0kg (p=0.002) Same tendency was also observed in esophageal surgical patients, but not statistically significant. Incidence of hypotension in Group I of both surgical procedures was lower than that in Group C (p<0.05). Conclusions. Although glucose dilution guided fluid management did not improve length of ventilation or ICU stay, results suggest that this management is useful to avoid excess postoperative fluid accumulation and reduce the incidence of hypotension.