Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2016 | Month : May | Volume : 10 | Issue : 5 | Page : UC01 - UC05

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)

Shalini Cynthia Sundaram, Serina Ruth Salins, Amar Nandha kumar, Grace Korula

1. Registrar, Department of Anaesthesia, Christian Medical College, Vellore, India. 2. Assistant Professor, Department of Anaesthesia, Christian Medical College, Vellore, India. 3. Consultant Anaesthetist, Department of Anaesthesia, Kovai Medical Center And Hospital, Coimbatore, India. 4. Professor Emeritus, Department of Anaesthesia, Christian Medical College, Vellore, India.

Correspondence Address :
Dr. Shalini Cynthia Sundaram,
Department of Anaesthesia, Christian Medical College, Vellore-632004, Tamil Nadu, India.


Introduction: Fluid management in neurosurgery presents specific challenges to the anaesthesiologist. Dynamic para-meters like Pulse Pressure Variation (PPV) have been used successfully to guide fluid management.

Aim: To compare PPV against Central Venous Pressure (CVP) in neurosurgical patients to assess hemodynamic stability and perfusion status.

Materials and Methods: This was a single centre prospective randomised control trial at a tertiary care centre. A total of 60 patients undergoing intracranial tumour excision in supine and lateral positions were randomised to two groups (Group 1, CVP n=30), (Group 2, PPV n=30). Intra-operative fluid management was titrated to maintain baseline CVP in Group 1(5-10cm of water) and in Group 2 fluids were given to maintain PPV less than 13%. Acid base status, vital signs and blood loss were monitored.

Results: Although intra-operative hypotension and acid base changes were comparable between the groups, the patients in the CVP group had more episodes of hypotension requiring fluid boluses in the first 24 hours post surgery. {CVP group median (25, 75) 2400ml (1850, 3110) versus PPV group 2100ml (1350, 2200) p=0.03} The patients in the PPV group received more fluids than the CVP group which was clinically significant. {2250 ml (1500, 3000) versus 1500ml (1200, 2000) median (25, 75) (p=0.002)}. The blood loss was not significantly different between the groups The median blood loss in the CVP group was 600ml and in the PPV group was 850 ml; p value 0.09.

Conclusion: PPV can be used as a reliable index to guide fluid management in neurosurgical patients undergoing tumour excision surgery in supine and lateral positions and can effectively augment CVP as a guide to fluid management. Patients in PPV group had better hemodynamic stability and less post operative fluid requirement.


Cerebral, Dynamic indices, Goal directed fluid therapy, Monitoring

How to cite this article :

Shalini Cynthia Sundaram, Serina Ruth Salins, Amar Nandha kumar, Grace Korula. 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). Journal of Clinical and Diagnostic Research [serial online] 2016 May [cited: 2018 Jul 16 ]; 10:UC01-UC05. Available from

DOI and Others

DOI: 10.7860/JCDR/2016/18377.7850

Date of Submission: Dec 16, 2015
Date of Peer Review: Jan 28, 2016
Date of Acceptance: Apr 02, 2016
Date of Publishing: May 01, 2016


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