{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:36:36Z","timestamp":1762353396186,"version":"3.37.3"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T00:00:00Z","timestamp":1695340800000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries.<\/jats:p><jats:p>\n          Materials and Methods\u2003This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8\u2009mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed.<\/jats:p><jats:p>\n          Statistical Analyses\u2003All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann\u2013Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables.<\/jats:p><jats:p>\n          Results\u2003The CVP group received significantly more intraoperative fluids than the PPV group (4,340\u2009\u00b1\u20091,010 vs. 3,540\u2009\u00b1\u2009740\u2009mL, p\u2009&lt;\u20090.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p\u2009=\u20090.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups.<\/jats:p><jats:p>\n          Conclusion\u2003The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.<\/jats:p>","DOI":"10.1055\/s-0043-1771364","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T23:04:28Z","timestamp":1695423868000},"page":"508-515","source":"Crossref","is-referenced-by-count":3,"title":["Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial"],"prefix":"10.1055","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5330-6009","authenticated-orcid":false,"given":"Janani","family":"Gopal","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2355-9133","authenticated-orcid":false,"given":"Shashi","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6057-2033","authenticated-orcid":false,"given":"Nidhi","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5875-5367","authenticated-orcid":false,"given":"Rudrashish","family":"Haldar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0983-0014","authenticated-orcid":false,"given":"Ruchi","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-6978","authenticated-orcid":false,"given":"Devendra","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4769-9106","authenticated-orcid":false,"given":"Prabhakar","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,9,22]]},"reference":[{"issue":"12","key":"ref1","first-page":"625","article-title":"Anaesthesia for neurosurgery","volume":"17","author":"O Hambidge","year":"2016","journal-title":"Neurointensive Care Neurosurg Anaesth."},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1093\/bja\/aem132","article-title":"Anaesthesia for elective neurosurgery","volume":"99","author":"J Dinsmore","year":"2007","journal-title":"Br J Anaesth"},{"issue":"S 01","key":"ref3","first-page":"S29","article-title":"Goal-directed fluid therapy in the perioperative setting","volume":"35","author":"J B Kendrick","year":"2019","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1097\/ALN.0000000000002603","article-title":"Perioperative fluid therapy for major surgery","volume":"130","author":"T E Miller","year":"2019","journal-title":"Anesthesiology"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.bja.2019.04.048","article-title":"The \u20185 Ts\u2019 of perioperative goal-directed haemodynamic therapy","volume":"123","author":"B Saugel","year":"2019","journal-title":"Br J Anaesth"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s13054-016-1309-2","article-title":"Fluid management of the neurological patient: a concise review","volume":"20","author":"M van der Jagt","year":"2016","journal-title":"Crit Care"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13613-016-0216-7","article-title":"Prediction of fluid responsiveness: an update","volume":"6","author":"X Monnet","year":"2016","journal-title":"Ann Intensive Care"},{"issue":"12","key":"ref8","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/s12471-013-0487-7","article-title":"Basic concepts of fluid responsiveness","volume":"21","author":"T GV Cherpanath","year":"2013","journal-title":"Neth Heart J"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/bja\/aet590","article-title":"Fluid responsiveness: an evolution of our understanding","volume":"112","author":"P E Marik","year":"2014","journal-title":"Br J Anaesth"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s13613-020-00679-3","article-title":"Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA)","volume":"10","author":"M LNG Malbrain","year":"2020","journal-title":"Ann Intensive Care"},{"issue":"05","key":"ref11","first-page":"UC01","article-title":"Intra-operative fluid management in adult neurosurgical patients undergoing intracranial tumour surgery: randomised control trial comparing pulse pressure variance (PPV) and central venous pressure (CVP)","volume":"10","author":"S C Sundaram","year":"2016","journal-title":"J Clin Diagn Res"},{"issue":"15","key":"ref12","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.3889\/oamjms.2019.682","article-title":"Pulse pressure variation-guided fluid therapy during supratentorial brain tumour excision: a randomized controlled trial","volume":"7","author":"A Hasanin","year":"2019","journal-title":"Open Access Maced J Med 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Lopes","year":"2007","journal-title":"Crit Care"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1378\/chest.07-2331","article-title":"Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares","volume":"134","author":"P E Marik","year":"2008","journal-title":"Chest"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/00000542-200508000-00026","article-title":"Changes in arterial pressure during mechanical ventilation","volume":"103","author":"F Michard","year":"2005","journal-title":"Anesthesiology"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1186\/s13054-018-2251-2","article-title":"Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? 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