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dc.contributor.authorMyles, Paul S-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorCorcoran, Tomas-
dc.contributor.authorForbes, Andrew-
dc.contributor.authorPeyton, Philip J-
dc.contributor.authorStory, David A-
dc.contributor.authorChristophi, Chris-
dc.contributor.authorLeslie, Kate-
dc.contributor.authorMcGuinness, Shay-
dc.contributor.authorParke, Rachael-
dc.contributor.authorSerpell, Jonathan-
dc.contributor.authorChan, Matthew T V-
dc.contributor.authorPainter, Thomas-
dc.contributor.authorMcCluskey, Stuart-
dc.contributor.authorMinto, Gary-
dc.contributor.authorWallace, Sophie-
dc.identifier.citationThe New England Journal of Medicine 2018; 378(24): 2263-2274-
dc.description.abstractGuidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion. In a pragmatic, international trial, we randomly assigned 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery. The primary outcome was disability-free survival at 1 year. Key secondary outcomes were acute kidney injury at 30 days, renal-replacement therapy at 90 days, and a composite of septic complications, surgical-site infection, or death. During and up to 24 hours after surgery, 1490 patients in the restrictive fluid group had a median intravenous-fluid intake of 3.7 liters (interquartile range, 2.9 to 4.9), as compared with 6.1 liters (interquartile range, 5.0 to 7.4) in 1493 patients in the liberal fluid group (P<0.001). The rate of disability-free survival at 1 year was 81.9% in the restrictive fluid group and 82.3% in the liberal fluid group (hazard ratio for death or disability, 1.05; 95% confidence interval, 0.88 to 1.24; P=0.61). The rate of acute kidney injury was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P<0.001). The rate of septic complications or death was 21.8% in the restrictive fluid group and 19.8% in the liberal fluid group (P=0.19); rates of surgical-site infection (16.5% vs. 13.6%, P=0.02) and renal-replacement therapy (0.9% vs. 0.3%, P=0.048) were higher in the restrictive fluid group, but the between-group difference was not significant after adjustment for multiple testing. Among patients at increased risk for complications during major abdominal surgery, a restrictive fluid regimen was not associated with a higher rate of disability-free survival than a liberal fluid regimen and was associated with a higher rate of acute kidney injury. (Funded by the Australian National Health and Medical Research Council and others; RELIEF number, NCT01424150 .).-
dc.titleRestrictive versus Liberal Fluid Therapy for Major Abdominal Surgery.-
dc.typeJournal Article-
dc.identifier.journaltitleThe New England Journal of Medicine-
dc.identifier.affiliationAlfred Hospital, Melbourne, Victoria, Australia-
dc.identifier.affiliationMonash University, Melbourne, Victoria, Australia-
dc.identifier.affiliationUniversity of Melbourne, Melbourne, Victoria, Australia-
dc.identifier.affiliationAustin Health, Heidelberg, Victoria, Australia-
dc.identifier.affiliationRoyal Perth Hospital, Perth, Australia-
dc.identifier.affiliationthe University of Western Australia, Perth, Australia-
dc.identifier.affiliationRoyal Melbourne Hospital, Parkville, Victoria, Australia-
dc.identifier.affiliationRoyal Adelaide Hospital, Adelaide, SA, Australia-
dc.identifier.affiliationDiscipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia-
dc.identifier.affiliationAuckland City Hospital, Auckland, New Zealand-
dc.identifier.affiliationMedical Research Institute of New Zealand, Wellington, New Zealand-
dc.identifier.affiliationChinese University of Hong Kong, Hong Kong-
dc.identifier.affiliationUniversity Health Network, Toronto-
dc.identifier.affiliationDerriford Hospital, Plymouth, United Kingdom-
dc.type.austinJournal Article-
dc.type.austinMulticenter Study-
dc.type.austinPragmatic Clinical Trial-
dc.type.austinRandomized Controlled Trial-
dc.type.austinResearch Support, Non-U.S. Gov't-
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