Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial.

2019-09

Weinberg, Laurence

Ianno, Damian

Churilov, Leonid

Mcguigan, Steven

Mackley, Lois

Banting, Jonathan

Shen, Shi Hong

Riedel, Bernhard

Nikfarjam, Mehrdad

Christophi, Christopher

Cardiac output

Complications

Fluid therapy

Hemodynamics

Hepatectomy

Monitoring

Surgery

Journal Article

0000-0001-7403-7680

0000-0002-9807-6606

0000-0003-4866-276X

10.1016/j.amsu.2019.07.003

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.

link

Annals of medicine and surgery 2019; 45: 45-53

Annals of medicine and surgery

2049-0801