(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?
International multi-centre RCT involving 3000 patients at an increased risk of complications undergoing major abdominal surgery.
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)
- No difference in disability free survival at 1 year
- 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.