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Crit Care. 2011;15(5):R226. doi: 10.1186/cc10466. Epub 2011 Sep 23.

Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery.

Author information

1
Division of Intensive Care, Department of Internal Medicine, Faculdade de Medicina de São José do Rio Preto, Av Faria Lima-5544, São José do Rio Preto, CEP-15090-000, Brazil. suzana-lobo@uol.com.br

Abstract

INTRODUCTION:

Optimal 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.

METHODS:

We 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.

RESULTS:

Eighty-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).

CONCLUSIONS:

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

TRIAL REGISTRATION:

ISRCTN: ISRCTN94984995.

PMID:
21943111
PMCID:
PMC3334772
DOI:
10.1186/cc10466
[Indexed for MEDLINE]
Free PMC Article
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