Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery

Wrzosek, Anna; Jakowicka-Wordliczek, Joanna; Zajączkowska, Renata; Serednicki, Wojciech; Jankowski, Miłosz; Bała, Małgorzata M; Polak, Maciej; Wordliczek, Jerzy

doi:10.1002/14651858.cd012767

Cited by 18 publications

(21 citation statements)

References 50 publications

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“…However, in our study, we found no statistically differences in the postoperative AKI between the CFT group and the GDFT group. Therefore, the intraoperative goal-directed fluid therapy appeared to be at lower risk of postoperative AKI than the restrictive regimen, which deserves more larger, higher-quality RCTs to further study [37].…”

Section: Discussionmentioning

confidence: 97%

Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

et al. 2021

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Background The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery. Methods This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded. Results Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p < 0.001) and produced significantly less urine output (200 ml [150–300] vs 400 ml [290–500]; p < 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h; p = 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h; p = 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients; p = 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p > 0.05). Conclusions Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications. Trial registration ChiCTR, ChiCTR1800018227. Registered 6 September 2018 - Retrospectively registered.

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Section: Discussionmentioning

confidence: 97%

Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

et al. 2021

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“…Moreover, our institutional intraoperative monitoring was traditional (static) versus an invasive (dynamic) approach, often used in goal-directed therapy. Nevertheless, a recent meta-analysis found no difference between restrictive fluid management and goal-directed methods 25 . It is also essential to consider that colloid use, especially albumin, has a high amount of sodium chloride, potentially leading to high complication rates, explaining the higher adjusted risk of complications in our study regarding albumin infusion.…”

Section: Discussionmentioning

confidence: 71%

“…Nevertheless, a recent meta-analysis found no difference between restrictive fluid management and goal-directed methods. 25 It is also essential to consider that colloid use, especially albumin, has a high amount of sodium chloride, potentially leading to high complication rates, explaining the higher adjusted risk of complications in our study regarding albumin infusion. As an institutional standard, colloid transfusion is reserved for prolonged operations and given after infusion of higher RL volumes.…”

Section: Discussionmentioning

confidence: 87%

Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality – Improving Standardized Practice

et al. 2022

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Objective: We aimed to determine a safe zone of intraoperative fluid management associated with the lowest postoperative complication rates without increased acute kidney injury (AKi) risk for elective colorectal surgery patients. Background: To date, standard practice within institutions, let alone national expectations related to fluid administration, are limited. This fact has perpetuated a quality gap. Methods: Elective colorectal surgeries between 2018 and 2020 were included. Unadjusted odds ratios (ORs) for postoperative ileus, prolonged LOS, and AKi were plotted against the rate of intraoperative RL infusion (mL/ kg/h) and total intraoperative volume. Binary logistic regression analysis, including fluid volumes as a confounder, was used to identify risk factors for postoperative complications. Results: A total of 2900 patients were identified. Of them, 503 (17.3%) patients had ileus, 772 (26.6%) patients had prolonged LOS, and 240 (8.3%) patients had AKI. The intraoperative fluid resuscitation rate (mg/kg/h) was less impactful on postoperative ileus, LOS, and AKI than the total amount of intraoperative fluid. A total fluid administration range between 300 mL and 2.7 L was associated with the lowest complication rate. Total intraoperative RL !2.7 L was independently associated with a higher risk of ileus (adjusted OR 1.465; 95% confidence interval 1.154-1.858) and prolonged LOS (adjusted OR 1.300; 95% confidence interval 1.047-1.613), but not AKI. Intraoperative RL 300 mL was not associated with an increased risk of AKI. Conclusion: Total intraoperative RL !2.7 L was independently associated with postoperative ileus and prolonged LOS in elective colorectal surgery patients. A new potential standard for intraoperative fluids will require anesthesia case planning (complexity and duration) to ensure total fluid volume meets this new opportunity to improve care.

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“…A recent article published in the Cochrane database 20 suggests that restrictive fluid therapy is superior to a liberal fluid therapeutic strategy. In a multicenter study, Brandstrup et al 21 investigated a homogenous collective of 172 patients undergoing major colorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

A restrictive dose of crystalloids in patients during laparoscopic cholecystectomy is safe and cost-effective: prospective, two-arm parallel, randomized controlled trial

Belavić¹,

Tokmadžić²,

Krijan³

et al. 2018

TCRM

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PurposeThere are no evidence-based guidelines for volume replacement during surgical procedures such as laparoscopic cholecystectomy. However, the administration of a restrictive volume of crystalloids could be more cost-effective and safe. This trial aimed to determine the effectiveness and safety of a restrictive regimen of crystalloids in patients during laparoscopic cholecystectomy by analyzing its cost-effectiveness and 1-year morbidity rate.Patients and methodsIn this randomized, prospective study, patients were assigned to one of three groups based on the volume of fluid administered: the restrictive group received 1 mL/kg/hr, the low liberal group received 5 mL/kg/hr, and the high liberal group received 15 mL/kg/hr of Ringer’s solution intraoperatively. There were 40 patients in each group. Each patient’s hemodynamic parameters and laboratory values (arterial blood gas and lactate levels) were measured together with their consumption of crystalloids, volatile anesthetics, and analgesics.ResultsAnalysis of the hemodynamic and laboratory parameters revealed no signs of global hypoperfusion in any of the groups analyzed. There was no significant difference in the duration of surgery and anesthesia, but the consumption of crystalloids, volatile anesthetics, and opioids was significantly lower in the restrictive group, compared with the low and high liberal groups. Although there was no significant difference in the 1-year morbidity among the groups, heart failure was observed in one patient in the high liberal group in the early postoperative period.ConclusionRestrictive fluid therapy during laparoscopic cholecystectomy is justified, safe, and more cost-effective than other options.

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Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery

Abstract: Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery.

Cited by 18 publications

References 50 publications

Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

Preoperative carbohydrate loading and intraoperative goal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality – Improving Standardized Practice

A restrictive dose of crystalloids in patients during laparoscopic cholecystectomy is safe and cost-effective: prospective, two-arm parallel, randomized controlled trial

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