Wed3November0903PM 11

The use of goal directed fluid and inotrope administration is associated with a reduction in:

True / False

Venous thrombosis Correct

Myocardial infarction Correct

Renal impairment Incorrect answer selected

Sepsis Correct

Long term mortality Correct

Explanation

Goal directed fluid and inotrope therapy is associated with a reduction in renal impairment, respiratory failure and postoperative wound infection.

Early randomised trials suggested the positive benefits of a restrictive fluid regimen in abdominal surgery, with faster return of bowel function, fewer complications and shorter hospital stay.

The results of the restrictive versus liberal fluid therapy for major abdominal surgery trial (RELIEF) were published in The New England Journal of Medicine in June 2018.

It was an international trial comparing outcomes following major abdominal surgery in patients who had increased risk of complications. 3000 patients were randomly allocated into one of two groups.

Restrictive intravenous-fluid regimen during and up to 24-hours after surgery (1490 patients) had a median IV fluid intake of 3.7 litres (interquartile range, 2.9-4.9L)

Liberal intravenous-fluid regimen during and up to 24-hours after surgery (1493 patients) had a median IV fluid intake of 6.1 litres (interquartile range, 5-7.4L)

Primary outcome between the two groups

Disability free survival at 1-year (P value 0.64)

Secondary outcomes between the two groups

The most statistically significance between the two groups was the incidence of acute kidney injury. The incidence was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P<0.001).

Other secondary outcomes included:

Anastomotic leak (P value 0.12)

Pulmonary oedema (P value 0.10)

Death at 90 days (P value 0.06)

References:

Grocott MP, Dushianthan A, Hamilton MA, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. Br J Anaesth. 2013;111:535-48.

Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery.

Myles P. et al. N Engl J Med 2018; 378:2263-2274.

DOI: 10.1056/NEJMoa1801601.

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