Research
Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery
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* Corresponding author: Suzana M Lobo suzana-lobo@uol.com.br
1 Division of Intensive Care, Department of Internal Medicine, Faculdade de Medicina de São José do Rio Preto, Av Faria Lima-5544, São José do Rio Preto, CEP-15090-000, Brazil
2 Division of Colorectal Surgery, Department of Surgery, Faculdade de Medicina de São José do Rio Preto, Av Faria Lima-5544, São José do Rio Preto, CEP-15090-000, Brazil
3 Department of Anesthesiology, Faculdade de Medicina de São José do Rio Preto, Av Faria Lima-5544, São José do Rio Preto, CEP-15090-000, Brazil
Critical Care 2011, 15:R226 doi:10.1186/cc10466
Published: 23 September 2011Abstract
Introduction
Optimal fluid management is crucial for patients who undergo major and prolonged surgery. Persistent hypovolemia is associated with complications, but fluid overload is also harmful. We evaluated the effects of a restrictive versus conventional strategy of crystalloid administration during goal-directed therapy in high-risk surgical patients.
Methods
We conducted a prospective, randomized, controlled study of high-risk patients undergoing major surgery. For fluid maintenance during surgery, the restrictive group received 4 ml/kg/hour and the conventional group received 12 ml/kg/hour of Ringer's lactate solution. A minimally invasive technique (the LiDCO monitoring system) was used to continuously monitor stroke volume and oxygen delivery index (DO2I) in both groups. Dobutamine was administered as necessary, and fluid challenges were used to test fluid responsiveness to achieve the best possible DO2I during surgery and for 8 hours postoperatively.
Results
Eighty-eight patients were included. The patients' median age was 69 years. The conventional treatment group received a significantly greater amount of lactated Ringer's solution (mean ± standard deviation (SD): 4, 335 ± 1, 546 ml) than the restrictive group (mean ± SD: 2, 301 ± 1, 064 ml) (P < 0.001). Temporal patterns of DO2I were similar between the two groups. The restrictive group had a 52% lower rate of major postoperative complications than the conventional group (20.0% vs 41.9%, relative risk = 0.48, 95% confidence interval = 0.24 to 0.94; P = 0.046).
Conclusions
A restrictive strategy of fluid maintenance during optimization of oxygen delivery reduces major complications in older patients with coexistent pathologies who undergo major surgery.
Trial registration
ISRCTN: ISRCTN94984995