Restrictive and liberal fluid administration in major abdominal surgery

Pang, Qianyun; Liu, Hongliang; Chen, Bin; Jiang, Yan

doi:10.15537/smj.2017.2.15077

Cited by 15 publications

(14 citation statements)

References 26 publications

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“…Interestingly, a recent large randomised controlled trial (RCT) assigning 2983 patients to either zero-balance or liberal strategy showed comparable disability-free survival outcome, although the zero-balance approach was associated with a higher rate of acute kidney injury [ 16 ]. As a matter of fact, this single study enrolled more patients than several previous RCTs regarding this topic, insofar, partially challenging previous results [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 89%

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

et al. 2021

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Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value = 0.001]. We found no difference in either early (p value = 0.33) or late (p value = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059.

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Section: Introductionmentioning

confidence: 89%

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

et al. 2021

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“…Literatürde hipotansiyon ve inotropik ilaçlardan kaçınılarak >2 mL kg sa -1 idrar çıkışının HİPEK sonrası böbrek hasarını önlemede yeterli olduğu belirtilmiştir (26) . Bir çalışmada, restriktif sıvı tedavisinin özellikle korkulan akut böbrek hasarı açısından etkili olmadığı, çok/az/çok az sıvı tedavileri ile artan şekilde daha çok intestinal perfüzyonun olumsuz etkilendiği bildirilmiştir (27) . Çalışmamızda, ameliyat boyunca liberal grupta ortalama 2.1 mL kg -1 sa -1 , restriktif grupta 1.1 mL kg -1 sa -1 idrar çıkışı olmuştur ve postoperatif ilk 7 gün takip edilen kreatinin değerleri normal sınırlarda seyretmiştir.…”

Section: Discussionunclassified

The Effect Of Intraoperative Restrictive Fluid Therapy On Postoperative Outcomes In Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy

Özay¹,

Salman²,

Bölükbaşı³

et al. 2021

Jarss

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INTRODUCTION: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRC) are effective multimodal treatment options in patients with peritoneal carcinomatosis. Procedures are long-lasting operations with excessive blood and fluid loss. Intraoperative fluid management is very important because of major hemodynamic, respiratory and metabolic changes. This study aims to investigate the effect of intraoperative restrictive fluid therapy on postoperative outcome in patients undergoing HIPEC and SRS. METHODS: Patients who underwent HIPEC and SRS in our clinic between 2014-2018 were included in the study. The demographic, intraoperative and postoperative data of all patients were retrospectively analyzed. The patients who underwent restrictive fluid replacement were named Group R, and the group with liberal fluid replacement was named Group L. RESULTS: It was observed that the mean age was 54.6 ± 11.4 years, the female gender was 60.5% and the malignancy originating from the gastrointestinal system was 76.3%. There was no effect of liberal and restrictive fluid treatments on postoperative minor and major complications, length of stay in hospital and intensive care, and mortality. DISCUSSION AND CONCLUSION: We concluded that intraoperative restrictive fluid therapy did not affect postoperative complications and mortality in HIPEC and SRS surgeries.

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“…This inconsistency might be due to the prescription method of the treatment fluid and the surgical method applied to patients in the two stud-ies (11). Neutral findings in renal complications after abdominal surgeries between patients receiving liberal and restrictive regimens have been reported in meta-analysis and clinical trials, as well (10,(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…The level of tissue oxygenation is directly affected by the cardiac output and the volume of circulating fluid, keeping in mind that the excessive increase of fluid in circulation will apply extra cardiac loads (7,8). In general, the strategy of substituting the restrictive volume of fluids is acceptable for certain surgeries (9,10). Monitoring the renal function while maintaining the cardiac output will help find the optimum strategy of intraoperative fluid therapy.…”

Section: Introductionmentioning

confidence: 99%

Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery

et al. 2020

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Background: Earlier studies have suggested the liberal administration of fluids in favor of reducing the risk of rhabdomyolysis in obese patients, but the results are conflicting. Objectives: The present study aimed at comparing the effects of liberal and restrictive fluid therapy on renal indices in laparoscopic gastric bypass surgery. Methods: In a double-blinded randomized clinical trial, 72 candidates of bariatric surgery were randomly assigned into two groups of restrictive and liberal fluid therapy. Indices, including BUN, creatinine, creatine kinase, GFR, and urine output were measured before and 24 hours after the surgery. The clinical trial was registered at IRCT.ir under code IRCT20170109031852N3. Results: There was no significant difference in BUN, creatinine, creatinine kinase, and GFR indices between the two groups of liberal and restrictive fluid therapy both before and 24 hours after surgery (P > 0.05). Intragroup comparisons before and after surgery revealed that BUN decreased in both groups after the surgery (P < 0.05). Also, creatinine and GFR values improved in patients who received a liberal fluid regimen, whereas these indices remained statistically unchanged in the restrictive group before and 24 hours after the surgery (P > 0.05). Conclusions: Two methods of liberal and restrictive fluid therapy have comparable effects on traditional renal functional indices in laparoscopic bariatric surgery. The clinical significance of observed differences in outcomes should be investigated in further studies. The use of early biomarkers of acute kidney injury is warranted.

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Restrictive and liberal fluid administration in major abdominal surgery

Cited by 15 publications

References 26 publications

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

The Effect Of Intraoperative Restrictive Fluid Therapy On Postoperative Outcomes In Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy

Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery

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