Clinical trial · Observational
Pulse Pressure Variation vs. Central Venous Pressure for Fluid Management in Intracranial Tumor Surgery
Comparison of Pulse Pressure Variation and Central Venous Pressure for Fluid Management Guidance in Intracranial Tumor Surgery
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 8, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260908-000001
Summary
Brief summary (as posted)
This study investigates the efficacy of pulse pressure variation (PPV) compared to central venous pressure (CVP) in guiding fluid management during intracranial tumor surgeries. Perioperative fluid therapy is critical to prevent complications arising from both hypovolemia (e.g., hypotension, tissue hypoperfusion, ischemia) and hypervolemia (e.g., pulmonary edema, delayed wound healing, infection). Traditional fluid therapy relies on static parameters such as CVP, which have limited sensitivity and specificity. Emerging technologies and dynamic parameters, including PPV and stroke volume variation (SVV), offer higher accuracy in evaluating fluid responsiveness. This randomized study includes 42 patients, aged 18-65 years, undergoing elective intracranial tumor surgery under general anesthesia. Patients are classified as ASA I-III and are randomized into two groups: 1. Group N: Fluid therapy guided by PPV. 2. Group S: Fluid therapy guided by CVP. The study follows standard perioperative protocols, with PPV (\>13%) and CVP (0-6 mmHg) used as primary parameters for fluid administration. Key outcomes include intraoperative fluid requirements (primary) and secondary parameters such as serum lactate levels, incidence of hypotension, brain relaxation scores, and ICU length of stay. PPV has been shown to be more reliable than CVP in predicting fluid responsiveness, particularly in mechanically ventilated patients with tidal volumes ≥8 mL/kg. However, its efficacy in neurosurgical patients remains underexplored. This study aims to determine if PPV can replace CVP as a superior guide for fluid therapy, enhancing patient outcomes and minimizing complications.
Conditions
Conditions (5)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Brain Surgery | — | UNRESOLVED | — |
| Brain Tumor Adult | Brain Neoplasm | ALIAS | 0.85 |
| Central Venous Pressure | — | UNRESOLVED | — |
| Fluid Management | — | UNRESOLVED | — |
| Pulse Pressure Variation | — | UNRESOLVED | — |
Interventions
Interventions (0)
Data not yet available
Design
Arms and outcomes
Arms (2)
- label
- PPV
- description
- Patients with intraoperative fluid management according to PPV parameters
- label
- CVP
- description
- patients with intraoperative fluid management according to CVP parameters
Primary outcomes (1)
- measure
- Fluid requirement (number of times needing bolus infusion-during surgery)
- timeFrame
- At 10-minutes intervals throughout the surgery
- description
- Fluid requirement (number of times needing bolus infusion) One bolus infusion 250 mL amount Bolus fluid requirement will be assessed every 15 minutes throughout the operation. Assesment will make two method: CVP and PPV. Will be to compare the intraoperative fluid requirement between the two groups. 1. CVP (Central Venous Pressure) group: In cases where CVP\<6 mmHg during the intraoperative period, patients will be given an additional 250 ml bolus crystalloid infusion over a 10 minute period and LVB will be re-evaluated. 2. PPV (Pulse Pressure Variation) group: In cases where the pulse pressure variations value is \>13%, patients will be given an additional 250 ml of crystalloid fluid over a 10 minute period and pulse pressure variations will be reassessed.
Eligibility
Eligibility (as posted)
- Sex
- All
- Minimum age
- 18 Years
- Maximum age
- 65 Years
Show eligibility criteria text
Inclusion Criteria: * ages of 18-65 * ASA (American Society of Anesthesiology) physical status classification score I-III * who will undergo elective intracranial mass surgery under general anesthesia Exclusion Criteria: * Patients with renal failure * mental retardation * arrhythmia * severe cardiopulmonary disease * hemodynamic instability * body mass index (BMI) \>40 kg/m2 * respiratory system compliance (Crs) \<30 mL/cmH2O * use of lactate-producing drugs such as metformin * lactate elevation at the beginning of the operation * tumor causing diabetes insipitus * patients who do not accept the procedure
References
Publications (19)
- RESULTBristow A, Shalev D, Rice B, Lipton JM, Giesecke AH Jr. Low-dose synthetic narcotic infusions for cerebral relaxation during craniotomies. Anesth Analg. 1987 May;66(5):413-6. doi: 10.1213/00000539-198705000-00007. PMID 2953270
- RESULTFaul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146. PMID 17695343
- RESULTRail B, Hicks WH, Oduguwa E, Barrie U, Pernik MN, Montgomery E, Tao J, Kenfack YJ, Mofor P, Adeyemo E, Edukugho D, Caruso J, Bagley CA, El Ahmadieh TY, Aoun SG. Transfusion Guidelines in Brain Tumor Surgery: A Systematic Review and Critical Summary of Currently Available Evidence. World Neurosurg. 2022 Sep;165:172-179.e2. doi: 10.1016/j.wneu.2022.06.077. Epub 2022 Jun 23. PMID 35752421
- RESULTGopal J, Srivastava S, Singh N, Haldar R, Verma R, Gupta D, Mishra P. Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial. Asian J Neurosurg. 2023 Sep 22;18(3):508-515. doi: 10.1055/s-0043-1771364. eCollection 2023 Sep. PMID 38152505
- RESULTVos JJ, Poterman M, Salm PP, Van Amsterdam K, Struys MM, Scheeren TW, Kalmar AF. Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds: a prospective observational study. Can J Anaesth. 2015 Nov;62(11):1153-60. doi: 10.1007/s12630-015-0464-2. Epub 2015 Sep 3. PMID 26335905
- RESULTSundaram SC, Salins SR, Kumar AN, Korula G. 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). J Clin Diagn Res. 2016 May;10(5):UC01-5. doi: 10.7860/JCDR/2016/18377.7850. Epub 2016 May 1. PMID 27437329