Evaluating Fluid Strategies in Thoracic Surgery Patients Utilizing a Goal Directed Approach

Evaluating Fluid Strategies in Thoracic Surgery Patients Utilizing a Goal Directed Approach

The purpose of this study is to conduct a prospective, randomized, controlled trial comparing a restrictive vs. conservative fluid strategy in thoracic surgery patients. Excessive perioperative fluid has been retrospectively implicated in the development postoperative acute lung injury (PALI) and pulmonary edema following lung resection. However, fluid restriction in these patients is not without risk and may compromise end organ perfusion (i.e. acute kidney injury). The hypothesis is that a conservative fluid approach in thoracic surgery patients will result in better end organ perfusion with fewer occasions of acute kidney injury (AKI) without causing an increase in postoperative acute lung injury or pulmonary edema.

Inclusion Criteria:

• between 18-89 years of age
• undergoing pulmonary lobectomy with open or video assisted thoracotomy

Exclusion Criteria:

• patient refusal
• pregnancy
• cardiac arrhythmia
• pacemaker dependency
• severe aortic insufficiency
• idiopathic hypertrophic subaortic stenosis
• prisoners
• decisionally challenged
• patients that refuse to receive intravenous fluid products made from human plasma (Albumin 5%)
• patients with skin infection or breakdown on their fingers
• severe peripheral vascular disease
• evidence of compromised finger perfusion will be excluded