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Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial.
- Source :
-
Archives of surgery (Chicago, Ill. : 1960) [Arch Surg] 2010 Dec; Vol. 145 (12), pp. 1193-200. - Publication Year :
- 2010
-
Abstract
- Objectives: To compare the influence of 2 volumes of fluid, integrated with goal-directed fluid therapy, on hypovolemia (a key trigger of tissue hypoperfusion) and central venous oxygen saturation (Scvo₂) and to assess their relationships with postoperative morbidity.<br />Design, Setting, and Patients: A prospective, randomized trial of 70 consecutive patients undergoing major abdominal surgery.<br />Interventions: Patients were randomly assigned to 6 mL/kg/h of crystalloid (a restrictive fluid strategy) or 12 mL/kg/h of crystalloid (a more conservative fluid strategy). In both groups, a fluid bolus was administered when respiratory variation in peak aortic flow velocity (ΔPV) was greater than 13%. Data on hypovolemia (ΔPV > 13%), Scvo₂, and postoperative complications were recorded for all patients.<br />Main Outcome Measures: Overall incidence of postoperative complications, especially anastomotic leak and sepsis.<br />Results: Overall incidence of complications, including postoperative anastomotic leak and sepsis, was higher in the restrictive group than in the conservative group (all P < .05). The number of patients with hypovolemia increased significantly in the restrictive group compared with the conservative group (P < .001). The perioperative mean Scvo₂ (P = .02) and mean minimum Scvo₂ (P = .04) were significantly lower in the restrictive group than in the conservative group. Multivariate analysis showed that both hypovolemia and mean minimum Scvo₂ were independently associated with anastomotic leak and sepsis.<br />Conclusions: Excessive fluid restriction increased the level of hypovolemia, leading to reduced Scvo₂ and thereby increased incidence of postoperative complications. Excessive fluid restriction should be applied cautiously in surgical patients.<br />Trial Registration: clinicaltrials.gov Identifier: NCT00852449.
- Subjects :
- Adult
Aged
Analysis of Variance
Central Venous Pressure
Confidence Intervals
Crystalloid Solutions
Digestive System Surgical Procedures methods
Female
Fluid Therapy standards
Follow-Up Studies
Humans
Hypovolemia prevention & control
Laparotomy adverse effects
Laparotomy methods
Male
Middle Aged
Monitoring, Physiologic methods
Multivariate Analysis
Odds Ratio
Oxygen Consumption physiology
Postoperative Complications mortality
Postoperative Complications prevention & control
Prospective Studies
Survival Rate
Treatment Outcome
Abdomen surgery
Fluid Therapy methods
Hospital Mortality trends
Intraoperative Care methods
Isotonic Solutions therapeutic use
Oxygen blood
Subjects
Details
- Language :
- English
- ISSN :
- 1538-3644
- Volume :
- 145
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Archives of surgery (Chicago, Ill. : 1960)
- Publication Type :
- Academic Journal
- Accession number :
- 21173294
- Full Text :
- https://doi.org/10.1001/archsurg.2010.275