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Title: Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial.
Austin Authors: Weinberg, Laurence ;Ianno, Damian;Churilov, Leonid ;Mcguigan, Steven;Mackley, Lois;Banting, Jonathan;Shen, Shi Hong;Riedel, Bernhard;Nikfarjam, Mehrdad ;Christophi, Christopher 
Affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Anesthesia, Peter MacCallum Cancer Hospital, Victoria, Australia
Statistics and Decision Analysis Academic Platform, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: Sep-2019 2019
Publication information: Annals of medicine and surgery 2019; 45: 45-53
Abstract: The effect a restrictive goal directed therapy (GDT) fluid protocol combined with an enhanced recovery after surgery (ERAS) programme on hospital stay for patients undergoing major liver resection is unknown. We conducted a multicentre randomized controlled pilot trial evaluating whether a patient-specific, surgery-specific intraoperative restrictive fluid optimization algorithm would improve duration of hospital stay and reduce perioperative fluid related complications. Forty-eight participants were enrolled. The median (IQR) length of hospital stay was 7.0 days (7.0:8.0) days in the restrictive fluid optimization algorithm group (Restrict group) vs. 8.0 days (6.0:10.0) in the conventional care group (Conventional group) (Incidence rate ratio 0.85; 95% Confidence Interval 0.71:1.1; p = 0.17). No statistically significant difference in expected number of complications per patient between groups was identified (IRR 0.85; 95%CI: 0.45-1.60; p = 0.60). Patients in the Restrict group had lower intraoperative fluid balances: 808 mL (571:1565) vs. 1345 mL (900:1983) (p = 0.04) and received a lower volume of fluid per kg/hour intraoperatively: 4.3 mL/kg/hr (2.6:5.8) vs. 6.0 mL/kg/hr (4.2:7.6); p = 0.03. No significant differences in the proportion of patients who received vasoactive drugs intraoperatively (p = 0.56) was observed. In high-volume hepatobiliary surgical units, the addition of a fluid restrictive intraoperative cardiac output-guided algorithm, combined with a standard ERAS protocol did not significantly reduce length of hospital stay or fluid related complications. Our findings are hypothesis-generating and a larger confirmatory study may be justified.
DOI: 10.1016/j.amsu.2019.07.003
ORCID: 0000-0001-7403-7680
PubMed URL: 31360460
ISSN: 2049-0801
Type: Journal Article
Subjects: Cardiac output
Fluid therapy
Appears in Collections:Journal articles

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