Abstract
Perioperative fluid and hemodynamic management have been much-debated topics over the last few years. Recently, a number of large trials have been published to help inform this debate. The Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) study is the largest trial to date of perioperative fluid management. The 3000-patient trial comparing 2 different fluid regimes showed that a restrictive fluid regimen during and up to 24 h after surgery was associated with an increase in acute kidney injury (AKI). This result is at odds with a recent trend to a more restrictive fluid approach during major surgery and suggests that practice may have become too restrictive. A moderately liberal (aiming for 1–2 l positive) or goal-directed approach is therefore recommended.
Highlights
Main text Optimal perioperative fluid and hemodynamic management remain topics of significant debate in perioperative medicine. One reason for this is that perioperative care has changed significantly over the last 10 years as approaches such as laparoscopic surgery and enhanced recovery after surgery (ERAS) pathways have become routine
The Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) study published in the New England Journal of Medicine in May 2018 is the largest trial published to date on perioperative fluid
One concern is that fewer than half of included patients were treated within a fully established enhanced recovery pathway this may reflect international variations in usual care. Another concern is that fluid management should be individualized with goal-directed therapy (GDT) rather than using a standardized fluid algorithm
Summary
Optimal perioperative fluid and hemodynamic management remain topics of significant debate in perioperative medicine One reason for this is that perioperative care has changed significantly over the last 10 years as approaches such as laparoscopic surgery and enhanced recovery after surgery (ERAS) pathways have become routine. The restrictive group in the Brandstrup study more closely resembles the liberal group in RELIEF with a weight gain of around 1 kg This difference may reflect differing cultures of perioperative care in different countries or it may be that fluid management has evolved in the 15 years since Brandstrup’s work. One concern is that fewer than half of included patients were treated within a fully established enhanced recovery pathway this may reflect international variations in usual care Another concern is that fluid management should be individualized with goal-directed therapy (GDT) rather than using a standardized fluid algorithm. Subgroup analyses show that the use of GDT and ERAS did not affect the primary results, suggesting that the findings are generalizable
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
