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|Title:||Restrictive versus liberal fluid therapy for major abdominal surgery|
|Citation:||New England Journal of Medicine, 2018; 378(24):2263-2274|
|Publisher:||Massachusetts Medical Society|
|P.S. Myles, R. Bellomo, T. Corcoran, A. Forbes, P. Peyton, D. Story, C. Christophi, K. Leslie, S. McGuinness, R. Parke, J. Serpell, M.T.V. Chan, T. Painter, S. McCluskey, G. Minto, and S. Wallace, for the Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group|
|Abstract:||Background: Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion. Methods In a pragmatic, international trial, we randomly assigned 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery. The primary outcome was disability-free survival at 1 year. Key secondary outcomes were acute kidney injury at 30 days, renal-replacement therapy at 90 days, and a composite of septic complications, surgical-site infection, or death. Results: During and up to 24 hours after surgery, 1490 patients in the restrictive fluid group had a median intravenous-fluid intake of 3.7 liters (interquartile range, 2.9 to 4.9), as compared with 6.1 liters (interquartile range, 5.0 to 7.4) in 1493 patients in the liberal fluid group (P<0.001). The rate of disability-free survival at 1 year was 81.9% in the restrictive fluid group and 82.3% in the liberal fluid group (hazard ratio for death or disability, 1.05; 95% confidence interval, 0.88 to 1.24; P = 0.61). The rate of acute kidney injury was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P<0.001). The rate of septic complications or death was 21.8% in the restrictive fluid group and 19.8% in the liberal fluid group (P = 0.19); rates of surgical-site infection (16.5% vs. 13.6%, P = 0.02) and renal-replacement therapy (0.9% vs. 0.3%, P = 0.048) were higher in the restrictive fluid group, but the between-group difference was not significant after adjustment for multiple testing. Conclusions: Among patients at increased risk for complications during major abdominal surgery, a restrictive fluid regimen was not associated with a higher rate of disability-free survival than a liberal fluid regimen and was associated with a higher rate of acute kidney injury.|
|Keywords:||Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group; Abdomen; Humans; Blood Loss, Surgical; Postoperative Complications; Hypotonic Solutions; Rehydration Solutions; Fluid Therapy; Digestive System Surgical Procedures; Risk Factors; Follow-Up Studies; Aged; Middle Aged; Female; Male; Acute Kidney Injury|
|Rights:||Copyright © 2018 Massachusetts Medical Society. All rights reserved.|
|Appears in Collections:||Medicine publications|
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