Comparison of systemic vascular resistance index-guided versus conventional fluid management on airway pressure, oxygenation and postoperative recovery in patients undergoing one-lung ventilation for thoracic surgery.

OBJECTIVE: To compare the effects of systemic vascular resistance index (SVRI)-guided goal-directed fluid therapy (GDFT) versus conventional fluid management on perioperative airway pressure, oxygenation, and postoperative recovery in thoracic surgery patients with one-lung ventilation (OLV), and to identify independent risk factors for postoperative pulmonary complications (PPCs). METHODS: A total of 386 patients were retrospectively enrolled and randomly split into a training set (n=270) and a validation set (n=116) at a 7:3 ratio. The training set was divided into SVRI group (n=155) and control group (n=115). Baseline data, airway pressure, oxygenation, recovery indicators, and 7-day PPCs were collected. Independent risk factors were screened by logistic regression; a nomogram was constructed and evaluated by ROC and calibration curves. RESULTS: Baseline characteristics were comparable between the groups (P>0.05). The SVRI group had lower airway pressure, fluid volume, infusion rate, recovery time, and PPCs incidence, as well as better oxygenation and urine output (all P<0.05). Ppeak ≥26.845 cmH2O, Pplat ≥21 cmH2O, ΔP ≥14.945 cmH2O, and PaO2/FiO2 <303.815 mmHg were independent risk factors for PPCs. The combined four-index model showed better predictive efficiency. CONCLUSION: SVRI-guided GDFT improves perioperative outcomes and reduces PPCs in OLV patients. The four indicators effectively predict PPCs, and their combined detection enhances risk stratification accuracy.