Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25964
Title: Effect of fluid strategy on stroke volume, cardiac output, and fluid responsiveness in adult patients undergoing major abdominal surgery: a sub-study of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial.
Austin Authors: Phan, Tuong D;Uda, Yoshiaki;Peyton, Philip J ;Kluger, Roman;Myles, Paul S
Affiliation: University of Melbourne, Melbourne, Australia
Alfred Hospital, Melbourne, Australia
Monash University, Clayton, Australia
St Vincent's Hospital Melbourne, Fitzroy, Australia
University of Melbourne, Melbourne, Australia
Austin Health
Issue Date: Apr-2021
metadata.dc.date: 2021-02-22
Publication information: British Journal of Anaesthesia 2021; 126(4): 818-825
Abstract: We designed a prospective sub-study of the larger Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial to measure differences in stroke volume and other haemodynamic parameters at the end of the intraoperative fluid protocols. The haemodynamic effects of the two fluid regimens may increase our understanding of the observed perioperative outcomes. Stroke volume and cardiac output were measured with both an oesophageal Doppler ultrasound monitor and arterial pressure waveform analysis. Stroke volume variation, pulse pressure variation, and plethysmographic variability index were also obtained. A passive leg raise manoeuvre was performed to identify fluid responsiveness. Analysis of 105 patients showed that the primary outcome, Doppler monitor-derived stroke volume index, was higher in the liberal group: restrictive 38.5 (28.6-48.8) vs liberal 44.0 (34.9-61.9) ml m-2; P=0.043. Similarly, there was a higher cardiac index in the liberal group: 2.96 (2.32-4.05) vs 2.42 (1.94-3.26) L min-1 m-2; P=0.015. Arterial-pressure-based stroke volume and cardiac index did not differ, nor was there a significant difference in stroke volume variation, pulse pressure variation, or plethysmographic variability index. The passive leg raise manoeuvre showed fluid responsiveness in 40% of restrictive and 30% of liberal protocol patients (not significant). The liberal fluid group from the RELIEF trial had significantly higher Doppler ultrasound monitor-derived stroke volume and cardiac output compared with the restrictive fluid group at the end of the intraoperative period. Measures of fluid responsiveness did not differ significantly between groups. ACTRN12615000125527.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25964
DOI: 10.1016/j.bja.2021.01.011
PubMed URL: 33632521
Type: Journal Article
Subjects: cardiac output
fluid responsiveness
fluid therapy
goal-directed fluid therapy
oesophageal Doppler ultrasound
passive leg raise
Appears in Collections:Journal articles

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