Fluid Therapy Research Articles

A Severe Clinical Case of Theileriosis with Terminal Wasting in Adult Cattle: A Veterinary Clinical and Pathology Case Report

This veterinary clinical and pathology case report describes a severe clinical case of theileriosis in adult cattle with prolonged recumbency and terminal wasting because of complications due to chronic theileriosis in two adult (2-year-old) Jersey-Friesian Cross. The case was referred to the large animal clinic of the University Veterinary Hospital (UVH), Faculty of Veterinary Medicine, Universiti Putra Malaysia (UPM). The animals were presented as recumbent, dull, depressed, hypothermic, dehydrated, and cachexic. There were poor responses of the patients to fluid therapy and non-steroidal anti-inflammatory treatments, and they both died within 24 hrs of clinical presentation. Haematology (complete blood count and serum biochemistry) results revealed haemoconcentration and faecal examinations were negative for liver fluke infestation and blood smear examination was positive for intraerythrocytic piroplasms of Theileria (0.01% parasitaemia). Post-mortem examination further revealed advanced cachexia, generalised serous atrophy of fat, hepatomegaly, hepatic congestion, pulmonary congestion, and pulmonary oedema. Histological findings revealed atrophy of the hepatic cord, hepatic congestion, splenic hemosiderosis, pulmonary oedema and congestion. The clinicopathological findings supported an aetiological diagnosis of a severe clinical case of Theileriosis with terminal wasting because of complications due to chronic Theileriosis infection.

Reflexive fluid therapy: From physiology to clinical practice

Introducción. La fluidoterapia es una intervención ampliamente usada en la práctica clínica. No obstante, su aplicación no está exenta de riesgos y demanda una evaluación cuidadosa de la tolerancia del paciente y su respuesta al volumen. La práctica empírica de la reanimación con líquidos puede ser potencialmente letal. El propósito de esta revisión fue proporcionar una visión general de los principios fisiológicos y terapéuticos para la administración de líquidos intravenosos en pacientes críticamente enfermos, abordando poblaciones especiales, como los pacientes quirúrgicos, sépticos y politraumatizados. Métodos. Se hizo una revisión narrativa a partir de artículos publicados en PUBMED, ScienceDirect y LILACS, entre 2001 y 2023. Para la búsqueda se emplearon los términos MESH fluid therapy, crystalloid solutions y colloids. Resultados. Se encontraron 371 artículos, de los cuales se seleccionaron los estudios clínicos aleatorizados, las revisiones narrativas, las revisiones sistemáticas y los metaanálisis que analizaron el rol de los cristaloides y coloides. Se incluyeron manuscritos publicados en fechas por fuera del rango de búsqueda, que se consideraron relevantes para la descripción de la fisiopatología y los fundamentos del uso de líquidos endovenosos. Conclusión. La reanimación reflexiva se fundamenta en un entendimiento holístico de la fisiología y la individualización de la fluidoterapia. El uso liberal de líquidos endovenosos tiene potenciales efectos nocivos y las estrategias de reanimación deben ser guiadas por medidas dinámicas y estáticas individuales, que proporcionan un panorama seguro para el manejo de los líquidos.

Polytrauma and Acute Kidney Injury: A Multidisciplinary Approach

The development of acute kidney injury (AKI) in polytrauma patients is a common and serious complication, with an incidence ranging from 6% to 50%. Polytrauma is a complex pathological condition that involves the collaboration of various specialists. On one hand, hemodynamic stabilization through fluid therapy and aminic support, with specific attack protocols, managed by anesthetists. On the other hand, if necessary, the initiation of renal replacement therapy such as Continuous Renal Replacement Therapy (CRRT), managed by nephrologists. CRRT is chosen both for managing fluid balance and ensuring the removal of toxic substances, as well as for proper control of electrolytes and acid-base balance.

Preliminary research on tailored fluid therapy in pigs: comparing customized ionic solutions with Hartmann’s solution

BackgroundFluid therapy in veterinary medicine is pivotal for treating various conditions in pigs; however, standard solutions, such as Hartmann’s solution, may not optimally align with pig physiology. This study explored the development and efficacy of a customized fluid therapy tailored to the ionic concentrations of pig blood, aiming to enhance treatment outcomes and safety in both healthy and diseased pigs.ResultsThe study involved two experiments: the first to assess the safety and stability of customized fluids in healthy pigs, and the second to evaluate the efficacy in pigs with clinical symptoms of dehydration. In healthy pigs, the administration of customized fluids showed no adverse effects, with slight alterations observed in pO2, hematocrit, and glucose levels in some groups. In symptomatic pigs, the customized fluid group did not show any improvement in clinical symptoms, with no significant changes in blood chemistry or metabolite levels compared to controls. The customized fluid group showed a mild increase in some values after administration, yet within normal physiological ranges. The study reported no significant improvements in clinical or dehydration status, attributing the observed variations in blood test results to the limited sample size and anaesthesia effects rather than fluid characteristics.ConclusionsCustomized fluid therapy, tailored to mimic the ionic concentrations of pig blood, appears to be a safe and potentially more effective alternative to conventional solutions such as Hartmann’s solution for treating pigs under various health conditions. Further research with larger sample sizes and controlled conditions is recommended to validate these findings and to explore the full potential of customized fluid therapy in veterinary practice.

Parenteral versus enteral fluids for infants hospitalized with bronchiolitis: The PREFER shared decision-making prospective observational study protocol.

Incorporating shared decision-making (SDM) with children and families in hospitals was a top priority identified by patients, caregivers, and clinicians. Bronchiolitis, a common and costly reason for hospitalization in children, is an exemplar condition to study SDM in hospitals. Internationally, clinical practice guidelines differ when recommending intravenous (IV or parenteral) or nasogastric (NG or enteral) fluids for hospitalized infants with bronchiolitis who are unsafe to be fed orally. While evidence indicates that either IV or NG fluids are safe and effective, parent involvement in SDM in selecting IV or NG fluids is unknown. Our aim is to generate knowledge of SDM with parents in choosing between IV or NG fluids and the benefits and harms of these two treatment options for hospitalized children with bronchiolitis. This is a multicenter, prospective, observational study, including children aged <12 months admitted to hospital with bronchiolitis requiring supplemental IV or NG fluids. The primary outcome will evaluate the extent of SDM in choosing IV versus NG fluids using the validated CollaboRATE tool. Secondary outcomes include the proportion of parents provided a choice of IV versus NG fluids; parent knowledge of fluid therapy; rate of fluids; length of hospital stay; and complications. This study will evaluate the extent of SDM in hospitalized infants with bronchiolitis who require IV or NG fluids and will evaluate both patient-centered and clinical outcomes that are relevant to clinical practice.

Evaluation of Cases of Foreign Body Ingestion in the Gastrointestinal Tract of Cats: 12 Cases

In this study, the operative treatment results of foreign body ingestion cases in 12 cats brought to Surgery Clinic of Siirt University Animal Health Practice and Research Hospital with various complaints between 2020 and 2023 were evaluated. As a result of radiographic examination, foreign bodies were detected in the stomachs of 3 patients and in the intestines of 9 patients. In the pre-operative period, the blood parameters of the patients were evaluated and all patients were administered fluid therapy and antibacterial treatment for prophylaxis. The foreign body was removed from the relevant area operatively under general anesthesia. In the post operative period, all patients except 1 (case no: 4) included in the study were hospitalized, and appropriate diet and post-operative care were applied. As a result, 11 (91.66%) of the 12 patients who underwent surgery in the study were discharged between post-operative 11th and 21st days without any complications. In the study, it was concluded that operative treatment was necessary in cases of foreign body ingestion in cats and that post-operative care was of great importance in prognosis.

The potential of the ultrasound method in diagnosing pulmonary edema in critically ill patients with liver failure

Background. Pulmonary edema is a common complication in critically ill patients. The liberal tactics of fluid therapy and pathological accumulation of extravascular lung water increase the risks of mortality in Intensive Care Unit patients. Timely and non-invasive diagnosis of pulmonary edema is a primary goal in the intensive care of patients in the Critical Care Unit. We prefer to use lung ultrasound with the registration of B-lines to diagnose lung edema. However, in our country, this method is not validated due to the lack of a sufficient number of clinical studies and necessary regulatory framework.Objective. To assess the potential of diagnostic ultrasonography for pulmonary edema in critically ill patients.Material and methods. A retrospective study was conducted on 27 patients, including 15 males and 12 females aged from 43 to 67 years old (mean age 45.05±17.2 years). All patients were in critical condition due either to acute liver failure, or acute-on-chronic liver failure, or early post-transplant liver graft failure, or posthepatectomy liver failure. Some patients had a systemic inflammatory response syndrome with the development of multiple organ failure and clinical signs of redistribution shock. All patients underwent ultrasound examination of the lungs, and had hemodynamic parameters measured using the transpulmonary thermodilution technique. The data obtained by the two diagnostic modalities were compared.Results. A significant correlation (p&lt;0.05) was found between the extravascular lung water index and the presence of lung edema. We identified a significant correlation (p&lt;0.05) between the number of B-lines and the presence of pulmonary edema. In assessing the relationship between the "B-line" parameter and the "EVLWI" parameter, a strong positive correlation was identified. The area under the ROC curve (AUC) was 0.9±0.06 with a 95% CI [0.77–1.00].Conclusions. Ultrasound data in diagnosing pulmonary edema have a significant correlation with the level of extravascular pulmonary water. Lung ultrasound is an accurate, non-invasive method for assessing extravascular lung water. It can be used for the rapid and accurate diagnosis of pulmonary edema.

The effect of restrictive compared to liberal intravenous fluid volume on hypotension in adults undergoing major abdominal surgery

In a cardiac output (CO) sub-study of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial, it was shown that restrictive fluid management was associated with lower cardiac index at the end of surgery. However, the association of the fluid protocol with intraoperative blood pressure was less clear. This paper primarily compares rates of hypotension between the two fluid regimens. The haemodynamic effects of these protocols may increase our understanding of perioperative fluid prescription. Using a data set of arterial pressure and cardiac output measurements, this observational cohort study primarily compares intraoperative hypotension rates defined by a mean arterial pressure < 65 mmHg between liberal and restrictive fluid protocols. Secondary analyses explore predictors of invasive mean arterial pressure and doppler-derived cardiac output, including fluid volume regimens and surgical duration. 105 patients had a combined total of 835 haemodynamic data capture events from the beginning to the end of the surgery. Here we report that a restrictive regimen is not associated with a greater proportion of participants who experience at least one episode of hypotension than the liberal regimen 64.1% vs. 61.5% (mean difference 2.6%, 95% CI − 15.9% to 21%, p = 0.78). Duration of surgery was associated with an increased risk of hypotension (OR 1.05, 1 to 1.1, p = 0.038). A fluid restriction protocol compared to liberal fluid administration is not associated with lower blood pressure.

Assessment of the fluid status and fluid therapy optimization in the emergency department: Is inferior vena cava a reliable marker?

Assessment of the fluid status and fluid therapy optimization in the emergency department: Is inferior vena cava a reliable marker?

Is the NICE Guideline for maintenance fluid therapy in adults in hospital appropriate?

The National Institute for Health and Care Excellence's (NICE) Guideline for Maintenance Fluid Therapy in Adults in Hospital is widely used, but the recommendations have not been evaluated properly. In this study, we investigated whether the recommendation of providing 25-30mL/kg/day of fluid and 1mmol/kg each of sodium and potassium is sufficient for human needs. First, we calculated the distribution of fluid between the extracellular fluid volume (ECV) and intracellular fluid volume (ICV) during a cross-over infusion experiment where 12 volunteers received 25mL/kg/day of either a high-sodium (154mmol/L) or low-sodium (54mmol/L) solution over 48h. Second, urine samples from 719 volunteers and clinical patients were used to quantify their renal water conservation and excretion of sodium and potassium. Third, retrospective analysis of a diet study was used to extrapolate how large the fluid intake and the electrolyte excretion likely had been in the 719 volunteers and hospital patients who delivered urine. The high-sodium fluid maintained the ECV but the ICV had decreased by 1.3L after 48h. The low-sodium fluid resulted in a volume deficit of 1.7L that equally affected the ECV and the ICV. Regression equations based on the diet study suggested that the daily intake of water in the 719 subjects averaged 2.6L and that 2mmol/kg of sodium and 1mmol/kg of potassium was excreted. The NICE guideline recommends too little water and sodium for a human to adequately maintain the ECV and ICV. EudraCT 2016-001846-24 and ISRCTN 12215472.

Endoscopic retrieval of oesophageal foreign body in a dachshund

Four-year-old male Dachshund dog was presented to Madras Veterinary College and Teaching Hospital with the history of gradual weight loss and chronic vomiting for more than twenty days. Previously the dog was treated in several places with anti-emetics, proton pump inhibitors, H2 blockers, fluid therapy and antibiotics but there was no improvement. On clinical examination the dog was severely dehydrated, increased skin tenting time and increased capillary refill time. Hematobiochemical assessment revealed mild hypoproteinemia and hypoalbuminemia. Radiographic examination of thorax and abdomen revealed no radio-opaque foreign body in the gastrointestinal tract and ultrasound examination also confirmed the same. Contrast radiographic examination revealed absence of megaesophagus and foreign body in gastrointestinal tract. Hence upper gastrointestinal endoscopy was performed and which revealed presence of plastic thread twine along the esophagus from the level of pharynx to cardia and the foreign body was retrieved using endoscopic forceps. Further the animal was treated with fluid therapy along with other supportive therapy. The dog was shown the clinical improvement after third day.

Successful management of viper envenomation in a Labrador dog

A nine months old male Labrador dog was presented to the Veterinary Clinical Complex, Gannavaram with a history of snake bite. Clinical signs exhibited include dullness, depression, frothy salivation, ataxia, edema and discoloration at paw region. Upon clinical examination fang marks were observed at left metatarsal region. Based on the history, identification of snake by the owner, clinical signs and whole blood clotting test it was diagnosed as viper snakebite. Neutrophilia, polycythemia and marginal lymphocytopenia were noticed. Treatment with poly valent anti snake venom, fluid therapy, tetanus toxoid, an antibiotic was carried out and the dog had uneventful recovery

Acute Tumour Lysis Syndrome associated with mediastinal lymphoma in a dog

An eleven-year-old non-descript female dog weighing about 27 kg presented to small animal clinical complex was diagnosed with lymphoma (Stage IV) based on the clinical signs, serum biochemistry, radiography, ultrasonographical examination and histopathological examination of FNAC sample taken from superficial lymph nodes. The University of Wisconsin -Madison Lymphoma CHOP-19 protocol was initiated on day one with vincristine and prednisolone acetate. On day three dog was presented with signs of dyspnoea, vomiting and generalized edema. Metabolic acidosis, hyperphosphatemia, hyperkalemia, hyperchloremia, azotemia were observed. These abnormalities led to a tentative diagnosis of acute tumor lysis syndrome (ATLS). Aggressive Fluid therapy and other supportive therapy was initiated but the animal died due to multiple organ failure.

Meta-analysis and trial sequential analysis of randomized controlled trials comparing aggressive versus non-aggressive intravenous fluid therapy in acute pancreatitis: an insight into the existence of type 2 error.

We aimed to evaluate comparative outcomes of aggressive versus non-aggressive intravenous fluid (IVF) therapy in patients with acute pancreatitis. A systematic search of electronic data sources and bibliographic reference lists were conducted. All randomized controlled trials (RCTs) reporting outcomes of aggressive versus non-aggressive IVF therapy in acute pancreatitis were included and their risk of bias were assessed. Effect sizes were determined for overall mortality, systemic inflammatory response syndrome (SIRS), sepsis, respiratory failure, pancreatic necrosis, severe pancreatitis, clinical improvement, AKI, and length of stay using random-effects modeling. Trial sequential analysis was conducted to determine risk of types 1 or 2 errors. We included 10 RCTs reporting 993 patients with acute pancreatitis who received aggressive (n=475) or non-aggressive (n=518) IVF therapy. Aggressive IVF therapy was associated with significantly higher rate of sepsis (OR: 2.68, P=0.0005) and longer length of stay (MD: 0.94, P<0.00001) compared with the non-aggressive approach. There was no statistically significant difference in mortality (RD: 0.02, P=0.31), SIRS (OR: 0.93, P=0.89), respiratory failure (OR: 2.81, P=0.07), pancreatic necrosis (OR: 1.98, P=0.06), severe pancreatitis (OR: 1.31, P=0.38), clinical improvement (OR: 1.12, P=0.83) or AKI (OR: 1.06, P=0.91) between the two groups. Sub-group analysis demonstrated higher morbidity and mortality associated with the aggressive approach in more severe disease. Trial sequential analysis detected risk of type 2 error. Aggressive IVF therapy may be associated with higher morbidity in patients with acute pancreatitis compared with the non-aggressive approach, particularly in patients with more severe disease. It may also prolong length of hospital stay. The available evidence is subject to type 2 error indicating the need for adequately powered RCTs.

Comparison of anaesthesia strategies on postoperative nausea and vomiting in laparoscopic sleeve gastrectomy: a randomised controlled trial

BackgroundIntra-operative anaesthesia management should be optimised to reduce the occurrence of postoperative nausea and vomiting in high-risk patients; however, a single intervention may not effectively reduce postoperative nausea and vomiting in such patients. This study assessed the effect of an optimised anaesthetic protocol versus a conventional one on postoperative nausea and vomiting in patients who underwent laparoscopic sleeve gastrectomy.MethodsA single-centre randomised trial was conducted at Peking University Shenzhen Hospital from June 2021 to December 2022. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h.ResultsPostoperative nausea and vomiting assessment at 0–3 h post-surgery revealed no significant differences between groups. However, at 3–24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group.ConclusionsThe incidence and severity of postoperative nausea and vomiting 3–24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery.Trial registrationThis trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).

Effect of Fluid Therapy on Acid-Base Balance in Patients Undergoing Clipping for Ruptured Intracranial Aneurysm: A Prospective Randomized Controlled Trial.

Objectives Neurosurgical patients often receive 0.9% normal saline (NS) during the perioperative period. Theoretically, a balanced salt solution (BSS) is better than 0.9% saline. We compared the effects of two different fluids on acid-base balance, renal function, and neurological outcome in patients who underwent clipping following subarachnoid hemorrhage from a ruptured intracranial aneurysm. Materials and Methods Patients in group NS ( n = 30) received 0.9% saline and group BSS ( N = 30) received BSS (Plasmalyte-A) in the perioperative period for 48 hours. Comparison of arterial pH, bicarbonate, and base deficit measured preoperatively, intraoperatively (first and second hour), and postoperatively (at 24 and 48 hours) was the primary outcome of the study. The secondary outcome compared serum electrolytes, renal function tests, urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C, and the neurological outcome using modified Rankin score (MRS) at discharge, 1, and 3 months. Results In group NS, significantly low pH at 1-hour intraoperative period was seen compared with group BSS (7.37 ± 0.06 vs. 7.40 ± 0.05, p = 0.024). The bicarbonate level in group NS was significantly lower and the base deficit was higher at second intraoperative hour (bicarbonate: 17.49 vs. 21.99 mEq/L, p = 0.001; base deficit: 6.41 mmol/L vs. 1.89 mmol/L, p = 0.003) and at 24 hours post-surgery (bicarbonate: 20.38 vs. 21.96 mEq/L, p = 0.012; base deficit: 3.56 mmol/L vs. 2.12 mmol/L, p = 0.034)). Serum creatinine was higher in group NS at 24 hours (0.66 vs. 0.52 mg/dL, p = 0.013) and 48 hours (0.62 vs. 0.53 mg/dL, p = 0.047). Serum urea, electrolytes, cystatin, urine NGAL, and MRS were comparable. Conclusion In neurosurgical patients undergoing clipping for ruptured intracranial aneurysm, using a BSS during the perioperative period is associated with a better acid-base and renal profile. However, the biomarkers of kidney injury and long-term outcomes were comparable.

Multifactorial case of ascites and anemia in a Golden Retriever involving Babesia sp. and Toxocara canis infections

A seven-year-old male Golden Retriever presented with lethargy, anorexia, abdominal enlargement, and weakness. Hematology tests revealed lymphocytosis, microcytic hypochromic anemia with anisocytosis, hypoalbuminemia, hyperglobulinemia, and elevated levels of alkaline phosphatase (ALP), blood urea nitrogen (BUN), and creatinine. Radiographic examination showed pneumonia, an abnormal heart shape resembling an inverted "D," and fluid accumulation in the abdominal cavity. Blood smears indicated a Babesia sp. infection. Additionally, the dog expelled a worm identified as Toxocara canis. The complex interaction between T. canis infection, multiple organ dysfunction, Babesia sp. infection, and malnutrition contributed to the development of ascites and anemia in this case. Treatment included abdominocentesis and fluid therapy. The dog was also prescribed furosemide, methylprednisolone, digoxin, Hematodin®, VipAlbumin®, and Drontal® for the worm infection. Unfortunately, the dog died on the 5th day of treatment due to dehydration and worsening anemia.

Revolutionizing Urolithiasis Management: A Paradigm Shift through Nutraceutical Interventions, Fluid Therapy and pH Maintenance - A Comprehensive Review

Urolithiasis is characterized by the formation of mineral stones within the urinary tract, is a significant global health concern impacting millions worldwide. This review article examines the multifaceted nature of urolithiasis, encompassing its epidemiology, etiology, diagnosis, and management strategies. Key factors influencing stone formation include biochemical changes, dietary habits, hydration levels, genetic predispositions, and environmental factors. Diagnostic imaging methods such as ultrasonography and computed tomography aids in accurate diagnosis, while treatment options range from extracorporeal shock wave lithotripsy to dietary modifications and fluid therapy. Nutraceuticals, particularly phytoconstituents rich in polyphenols and alkaloids, offer promising avenues for managing urolithiasis by inhibiting crystal formation and supporting kidney function. Moreover, optimizing fluid intake and maintaining urinary pH levels play pivotal role in preventing stone recurrence. Prospects lie in the refinement of nutraceutical formulations, the integration of wearable technology for monitoring, and comprehensive clinical investigations to establish safety and efficacy. Ultimately, this review underscores the importance of holistic approaches to mitigating the burden of urolithiasis and improving patient outcomes. Keywords: Extracorporeal Shock Wave Lithotripsy, Epidemiology, Fluid Therapy, Nutraceuticals, Urolithiasis.

Intraoperative goal-directed fluid therapy in adult patients undergoing craniotomies under general anaesthesia: A systematic review and meta-analysis with trial sequential analysis.

Goal-directed fluid therapy (GDFT) has conflicting evidence regarding outcomes in neurosurgical patients. This meta-analysis aimed to compare the effect of GDFT and conventional fluid therapy on various perioperative outcomes in patients undergoing neurosurgical procedures. A comprehensive literature search was conducted using PubMed, EMBASE, Scopus, ProQuest, Web of Science, EBSCOhost, Cochrane and preprint servers. The search was conducted up until 16 October 2023, following PROSPERO registration. The search strategy included terms related to GDFT, neurosurgery and perioperative outcomes. Only randomised controlled trials involving adult humans and comparing GDFT with standard/liberal/traditional/restricted fluid therapy were included. The studies were evaluated for risk of bias (RoB), and pooled estimates of the outcomes were measured in terms of risk ratio (RR) and mean difference (MD). No statistically significant difference was observed in neurological outcomes between GDFT and conventional fluid therapy [RR with 95% confidence interval (CI) was 1.10 (0.69, 1.75), two studies, 90 patients, low certainty of evidence using GRADEpro]. GDFT reduced postoperative complications [RR = 0.67 (0.54, 0.82), six studies, 392 participants] and intensive care unit (ICU) and hospital stay [MD (95% CI) were -1.65 (-3.02, -0.28) and -0.94 (-1.47, -0.42), respectively] with high certainty of evidence. The pulmonary complications were significantly lower in the GDFT group [RR (95% CI) = 0.55 (0.38, 0.79), seven studies, 442 patients, high certainty of evidence]. Other outcomes, including total intraoperative fluids administered and blood loss, were comparable in GDFT and conventional therapy groups [MD (95% CI) were -303.87 (-912.56, 304.82) and -14.79 (-49.05, 19.46), respectively]. The perioperative GDFT did not influence the neurological outcome. The postoperative complications and hospital and ICU stay were significantly reduced in the GDFT group.

Renal hemodynamic monitoring-guided precision fluid therapy in patients with septic shock.

Renal hemodynamic monitoring-guided precision fluid therapy in patients with septic shock.