Liberal versus restrictive fluid management in abdominal surgery: a meta-analysis

Jia, Fu‐Jun; Yan, Qiaoyuan; Sun, Qi; Tuxun, Tuerhongjiang; Liu, Hui; Shao, Li

doi:10.1007/s00595-016-1393-6

Cited by 26 publications

(27 citation statements)

References 36 publications

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“…[ 4 ] These interesting findings shed light on the results of the meta- analysis of Jia et al who showed that patients who had a “restrictive” IFT model had a shorter hospital stay and a faster recovery, although no improvement in survival was proved. [ 22 ] The results of the ongoing OPTIMISE II study should provide new evidence in terms of IFT. [ 23 ] The fundamental goal of IFT is to maintain physiological fluid and electrolyte balance, in order to avoid excessive loading of water, sodium, and chloride.…”

Section: Discussionmentioning

confidence: 99%

Clinical practice on intra-operative fluid therapy in Poland

Szczepańska

Pluta²,

Krzych³

2020

Medicine

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Intra-operative fluid therapy (IFT) is the cornerstone of peri-operative management as it may significantly influence the treatment outcome. Therefore, we sought to evaluate nationwide clinical practice regarding IFT in Poland. A cross-sectional, multicenter, point-prevalence study was performed on April 5, 2018, in 31 hospitals in Poland. Five hundred eighty-seven adult patients undergoing non-cardiac surgery were investigated. The volume and type of fluids transfused with respect to the patient and procedure risk were assessed. The study group consisted of 587 subjects, aged 58 (interquartile range [IQR] 40–67) years, including 142 (24%) American Society of Anesthesiology Physical Status (ASA-PS) class III+ patients. The median total fluid dose was 8.6 mL kg −1 h −1 (IQR 6–12.5), predominantly including balanced crystalloids (7.0 mL kg −1 h −1 , IQR 4.9–10.6). The dose of 0.9% saline was low (1.6 mL kg −1 h −1 , IQR 0.8–3.7). Synthetic colloids were used in 66 (11%) subjects. The IFT was dependent on the risk involved, while the transfused volumes were lower in ASA-PS III+ patients, as well as in high-risk procedures ( P < .05). The practice of IFT is liberal but is adjusted to the preoperative risk. The consumption of synthetic colloids and 0.9% saline is low.

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Section: Discussionmentioning

confidence: 99%

Clinical practice on intra-operative fluid therapy in Poland

Szczepańska

Pluta²,

Krzych³

2020

Medicine

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“…All the four systematic reviews reporting results of meta-analyses on this topic [34][35]81,82] have concluded that compared with liberal fluid therapy, restrictive fluid therapy can reduce complications and should be advised as the preferred fluid-management policy.…”

Section: Discussionmentioning

confidence: 99%

“…Some papers based on subgroup analysis have demonstrated that restrictive fluid therapy and liberal conventional therapy have similar incidences of overall and cardiopulmonary complications [35] . A more recent study has shown that compared with liberal fluid regimen one year after surgery, restrictive fluid regimen leads to a higher rate of acute kidney injury [36] .…”

Section: Introductionmentioning

confidence: 99%

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

Cai

Tang

et al. 2019

Preprint

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Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology: We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Among the 472 articles selected from the databases, based on abstract reading, 272 articles were excluded according to the criteria in Figure 1. After reading the complete text, among the 78 remaining articles, excluded were 15 articles with no relevant data about the outcome of restrictive fluid therapy for major abdominal surgery, 54 that were not RCTs, 2 that were meta-analyses, and 7 that were from the same trial. Finally, 11 RCTs published between 2000 and 2018 that compared restrictive fluid therapy with liberal fluid therapy were included. Two studies by the same team were taken as one trial and shared the same study number because some data from the two studies were complementary.. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: the current meta-analysis assessed the effects of restrictive fluid therapy in a meticulous way. Though the large proportional reduction in risk of complications as indicated in the previous literature was not confirmed, moderate but clinically notable reduction in complications is still worth our attention. The application of restrictive fluid therapy requires communication and cooperation between medical workers and patients. RCTs on restrictive fluid therapy with long-term follow-up are needed. Hospital costs and quality of life after surgery should also be taken into account. Furthermore, the benefits of restrictive fluid therapy in elderly patients and patients who have undergone other surgeries might be the focus of future research..

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“… 115 – 119 In the nonfree flap population, meta-analyses of RCTs reaffirm the value of balanced fluid therapy in reducing perioperative complications and LOS. 120 , 121 There are no studies evaluating GDFT, which uses hemodynamic monitoring to guide fluid management, in microvascular breast reconstruction. However, multiple meta-analyses on GDFT in surgical patients demonstrate reductions in complications and LOS compared to standard or liberal fluid resuscitation models.…”

Section: Evidence-based Recommendations For Components Of Eras Protocmentioning

confidence: 99%

Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives

Parikh¹,

Myckatyn²

2018

JPR

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The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.

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Liberal versus restrictive fluid management in abdominal surgery: a meta-analysis

Abstract: Restrictive fluid therapy and liberal conventional therapy were associated with similar rates of overall and cardiopulmonary complications; however, restrictive fluid therapy was associated with a more rapid recovery and a shorter length of hospital stay.

Cited by 26 publications

References 36 publications

Clinical practice on intra-operative fluid therapy in Poland

Clinical practice on intra-operative fluid therapy in Poland

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives

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