Comparison of pulse pressure variation and central venous pressure for fluid management guidance in intracranial tumor surgery

Perioperative fluid management is critical in neurosurgery because fluid overload can lead to cerebral edema and inadequate fluid therapy can lead to cerebral ischemia. Pulse pressure variation (PPV), a dynamic parameter used to assess fluid responsiveness, has been demonstrated to provide more effective fluid management compared to static parameters such as central venous pressure (CVP). The present study aimed to compare PPV and CVP for the guidance of intraoperative fluid management in patients undergoing intracranial tumor surgery. 42 patients aged 18–65 years with ASA physical status I–III, scheduled for intracranial tumor surgery were included in the study. Patients were randomly allocated to two groups receiving fluid therapy guided by either PPV or CVP before surgery. Intraoperative total crystalloid volume, number of hypotensive episodes, vasopressor requirements, amount of blood loss, brain relaxation score, correlation between PPV and CVP, lactate and creatinine levels and length of stay in intensive care unit (ICU) were recorded. A comparison of the total crystalloid volume (1791 mL and 2311 mL, p=0.004) number of hypotensive episodes (0.00 [0.00–1.00] vs. 2.00 [1.00–3.00], p=0.002), vasopressor requirement (3 vs. 16, p<0.001), amount of blood loss (342.86±59.76 vs. 285.71±105.05, p=0.036), and lactate level measured at the 12 hours after surgery (1.67±0.58 vs. 2.23±0.86, p=0.017) observed a significant difference between the PPV and CVP groups. PPV and CVP were not well correlated. Brain relaxation scores, creatinine level and length of stay in ICU were similar between the groups. In conclusion, PPV-guided fluid management was observed to reduce total crystalloid volume, the number of hypotensive episodes and vasopressor requirements, as well as lower postoperative lactate level. It was concluded that PPV provides more effective guidance in the assessment of fluid responsiveness and may improve safety in neurosurgical patients. Keywords: pulse pressure variation, central venous pressure, fluid management, intracranial tumor surgery, goal directed fluid therapy