(originally presented by Dr Nathan Hewitt)

“Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery”

AIM OF TRIAL

In adult patients undergoing major elective abdominal surgery, does a restrictive fluid regimen, compared with a liberal fluid regimen, reduce complications and improve disability-free survival?

TRIAL DESIGNED

International multi-centre RCT involving 3000 patients at an increased risk of complications undergoing major abdominal surgery.

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RESULTS

Amount of fluid administered

  • 3.7 liters (interquartile range, 2.9 to 4.9) vs 6.1 liters (interquartile range, 5.0 to 7.4)

Primary end-point

  • No difference in disability free survival at 1 year

Secondary end-points

  • Significantly higher risk of acute kidney injury in the restrictive group.
  • Possible increased risk of surgical site infections and renal replacement therapy in the restrictive group.

 

SHOULD I CHANGE MY PRACTICE?

Yes, based on this study, a moderately liberal IVF therapy in the perioperative period would be preferable to a restrictive approach.

Other ERAS principles should still be encouraged when appropriate, however regarding perioperative fluid administration, a moderately liberal approach should be adopted.

 

Links:

Read the trial here

After you’ve read the article, check out this great editorial based on the trial

If you don’t like to read, try this PODCAST from one of the lead authors

 

 

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