Effects of Goal-Directed Fluid Therapy Guided by Inferior Vena Cava Collapsibility Index on Hemodynamics and Enhanced Recovery in Patients Undergoing Lower Limb Surgeries: A Randomized Study

Abdelkader, Mahmoud; Saleh, Zaki Taha; Abdelgalel, Essam Fathi; Kamel, Alshaimaa Abdel Fattah

doi:10.21608/zumj.2025.367954.3879

Effects of Goal-Directed Fluid Therapy Guided by Inferior Vena Cava Collapsibility Index on Hemodynamics and Enhanced Recovery in Patients Undergoing Lower Limb Surgeries: A Randomized Study

Document Type : Original Article

Authors

¹ Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Zagazig University

² Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University

10.21608/zumj.2025.367954.3879

Abstract

Background: Goal-directed fluid therapy (GDFT) guided by IVC Collapsibility Index maintains euvolemia and enhances recovery under the Enhanced Recovery After Surgery (ERAS) protocol. The primary aim of the study was to record the effect of GDFT guided by IVC Collapsibility Index and conventional fluid management on Mean Arterial Pressure. The secondary aim was to measure heart rate, oxygen saturation, peripheral perfusion index, intraoperative fluid intake, intraoperative urine output, incidence of hypotension or bradycardia and the number of patients that received Atropine and Ephedrine in patients undergoing lower limb orthopedic surgeries under spinal anesthesia.

Methods: This prospective randomized controlled trial was performed on 46 patients allocated into two groups: the GD group (n=23) received intraoperative fluid management guided by IVC collapsibility index, while the C group (n=23) followed conventional fluid therapy.

Results: The GD group had significantly lower intraoperative fluid intake (978.26±270.87 mL vs. 1623.91±138.06 mL, p=0.0001) and urine output (264.13±106.29 mL vs. 400±116.53 mL, p=0.0001). The GD group also demonstrated significantly reduced PACU stay (2.5 vs. 3.9 hours, p=0.029), shorter hospital stays (12 vs. 16 days, p=0.0373), and higher QoR-40 scores (188.44±4.33 vs. 184.26±4.69, p=0.003). intraoperative hemodynamics were comparable between the studied groups (p>0.05). However, both groups did not experience substantially different postoperative complications (p>0.05).

Conclusion: Ultrasound inferior vena cava collapsibility index is a non-invasive, reliable and effective method to guide intraoperative Goal-Directed Fluid Therapy and enhanced recovery with stable hemodynamics in patients undergoing lower limb orthopedic surgeries under spinal anesthesia compared to traditional method of fluid therapy.

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