Comparison of Intraoperative Fluid by Goal-Directed and Conventional Fluid Administration in Patients Undergoing Early Decompressive Craniectomy: A Prospective Randomized Controlled Trial

Abstract Optimal fluid administration is important following traumatic brain injury (TBI) due to its associated fluid imbalance and cardiovascular abnormalities. Liberal use of fluids may be associated with overload and adverse cardiovascular effects. Hence, the study was conducted to compare the effect of goal-directed fluid therapy (GDT) with conventional fluid therapy (CFT) in moderate to severe TBI patient scheduled for early decompressive craniectomy. Sixty-four patients with moderate to severe TBI were randomly allocated into Group A (goal-directed therapy [GDT]) in which intraoperative fluid administration was guided by dynamic parameters using FloTrac and Group B (conventional fluid therapy [CFT]) in which fluid was administered to target a mean arterial pressure of 70 mm Hg. The primary objective was to compare the intraoperative fluid volume administered. Comparison of blood loss, urine output, ventilator days, ICU days, and hospital days, were secondary outcomes. There was no statistical difference in intraoperative fluid volume between groups (2,567 vs. 2,670 mL; p = 0.51) with lesser episodes of hypotension in Group A (38 vs. 45). Group A had a significant drop in lactate (0.95 vs. 0.17; p = 0.00) and difference in hematocrit value was significantly lower in group A (9.52 vs. 12.04; p 0.04). There was no significant difference in blood loss (p = 0.77), urine output (p = 0.22), ventilator days (p = 0.20), ICU days (p = 0.23), and length of hospital stay (p = 0.39). GDT had no difference in intraoperative fluid volume but fewer hypotension episodes, more drop of lactate, and lesser fall in hematocrit as compared with CFT in moderate to severe TBI patients undergoing early decompressive craniectomy.