Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgeryReport as inadecuate




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Critical Care

, 15:R226

First Online: 23 September 2011Received: 28 June 2011Revised: 16 August 2011Accepted: 23 September 2011

Abstract

IntroductionOptimal fluid management is crucial for patients who undergo major and prolonged surgery. Persistent hypovolemia is associated with complications, but fluid overload is also harmful. We evaluated the effects of a restrictive versus conventional strategy of crystalloid administration during goal-directed therapy in high-risk surgical patients.

MethodsWe conducted a prospective, randomized, controlled study of high-risk patients undergoing major surgery. For fluid maintenance during surgery, the restrictive group received 4 ml-kg-hour and the conventional group received 12 ml-kg-hour of Ringer-s lactate solution. A minimally invasive technique the LiDCO monitoring system was used to continuously monitor stroke volume and oxygen delivery index DO2I in both groups. Dobutamine was administered as necessary, and fluid challenges were used to test fluid responsiveness to achieve the best possible DO2I during surgery and for 8 hours postoperatively.

ResultsEighty-eight patients were included. The patients- median age was 69 years. The conventional treatment group received a significantly greater amount of lactated Ringer-s solution mean ± standard deviation SD: 4, 335 ± 1, 546 ml than the restrictive group mean ± SD: 2, 301 ± 1, 064 ml P < 0.001. Temporal patterns of DO2I were similar between the two groups. The restrictive group had a 52% lower rate of major postoperative complications than the conventional group 20.0% vs 41.9%, relative risk = 0.48, 95% confidence interval = 0.24 to 0.94; P = 0.046.

ConclusionsA restrictive strategy of fluid maintenance during optimization of oxygen delivery reduces major complications in older patients with coexistent pathologies who undergo major surgery.

Trial registrationISRCTN: ISRCTN94984995

Electronic supplementary materialThe online version of this article doi:10.1186-cc10466 contains supplementary material, which is available to authorized users.

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Author: Suzana M Lobo - Luis S Ronchi - Neymar E Oliveira - Paulo G Brandão - Adriano Froes - Geni S Cunrath - Kátia G Nish

Source: https://link.springer.com/



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