1. A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative Fluid Management Strategy Compared With Usual Care in Participants After Cardiac Surgery: The Fluids After Bypass Study.
- Author
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Parke, Rachael L., Gilder, Eileen, Gillham, Michael J., Walker, Laurence J. C., Bailey, Michael J., McGuinness, Shay P., and Fluids After Bypass Study Investigators
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CARDIAC surgery , *BOLUS radiotherapy , *SURGICAL clinics , *FLUIDS , *QUALITY of life , *FLUID therapy , *MORPHOGENESIS , *LENGTH of stay in hospitals , *INTENSIVE care units , *RESEARCH , *RESEARCH methodology , *POSTOPERATIVE care , *MEDICAL cooperation , *EVALUATION research , *MEDICAL protocols , *COMPARATIVE studies , *RANDOMIZED controlled trials , *HEMODYNAMICS ,PREVENTION of surgical complications - Abstract
Objectives: There is little evidence to guide fluid administration to patients admitted to the ICU following cardiac surgery. This study aimed to determine if a protocolized strategy known to reduce fluid administration when compared with usual care reduced ICU length of stay following cardiac surgery.Design: Prospective, multicenter, parallel-group, randomized clinical trial.Setting: Five cardiac surgical centers in New Zealand conducted from November 2016 to December 2018 with final follow-up completed in July 2019.Patients: Seven-hundred fifteen patients undergoing cardiac surgery; 358 intervention and 357 usual care.Interventions: Randomization to protocol-guided strategy utilizing stroke volume variation to guide administration of bolus fluid or usual care fluid administration until desedation or up to 24 hours. Primary outcome was length of stay in ICU. Organ dysfunction, mortality, process of care measures, patient-reported quality of life, and disability-free survival were collected up to day 180.Measurements and Main Results: Overall 666 of 715 (93.1%) received at least one fluid bolus. Patients in the intervention group received less bolus fluid (median [interquartile range], 1,000 mL [250-2,000 mL] vs 1,500 mL [500-2,500 mL]; p < 0.0001) and had a lower overall fluid balance (median [interquartile range], 319 mL [-284 to 1,274 mL] vs 673 mL [38-1,641 mL]; p < 0.0001) in the intervention period. There was no difference in ICU length of stay between the two groups (27.9 hr [21.8-53.5 hr] vs 25.6 hr [21.9-64.6 hr]; p = 0.95). There were no differences seen in development of organ dysfunction, quality of life, or disability-free survival at any time points. Hospital mortality was higher in the intervention group (4% vs 1.4%; p = 0.04).Conclusions: A protocol-guided strategy utilizing stroke volume variation to guide administration of bolus fluid when compared with usual care until desedation or up to 24 hours reduced the amount of fluid administered but did not reduce the length of stay in ICU. [ABSTRACT FROM AUTHOR]- Published
- 2021
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