Perioperative Fluid Management Strategies in Major Surgery: A Stratified Meta-Analysis

@article{Corcoran2012PerioperativeFM,
  title={Perioperative Fluid Management Strategies in Major Surgery: A Stratified Meta-Analysis},
  author={Tom{\'a}s B Corcoran and Julia Emma Joy Rhodes and S. Clarke and Paul S. Myles and Kwok M. Ho},
  journal={Anesthesia \& Analgesia},
  year={2012},
  volume={114},
  pages={640–651}
}
BACKGROUND: Both “liberal” and “goal-directed” (GD) therapy use a large amount of perioperative fluid, but they appear to have very different effects on perioperative outcomes. We sought to determine whether one fluid management strategy was superior to the others. METHODS: We selected randomized controlled trials (RCTs) on the use of GD or restrictive versus liberal fluid therapy (LVR) in major adult surgery from MEDLINE, EMBASE, PubMed (1951 to April 2011), and Cochrane controlled trials… 

Figures and Tables from this paper

Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery.

Whether RFT may be more beneficial than GDFT for adults undergoing major non-cardiac surgery is investigated and the evidence on this is also very uncertain.

Effects of perioperative fluid management on postoperative outcomes in liver transplantation: a systematic review protocol

A systematic review aimed at evaluating the effects of restrictive perioperative fluid management strategies compared to liberal ones on clinically significant postoperative outcomes hopes to improve the understanding of the available evidence and help inform future clinical trials.

Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

A systematic review to evaluate the effects of restrictive perioperative fluid management strategies, compared with liberal ones, on postoperative outcomes in adult liver transplant recipients did not find any association between restrictive fluid Management strategies and AKI, but it was observed possible protective effects of intraoperative restrictive fluidmanagement strategies on other outcomes.

Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial

The RELIEF trial is a pragmatic, multicentre, randomised, controlled trial evaluating perioperative fluid replacement in major abdominal surgery and the primary outcome is disability-free survival at 1 year after surgery.

Restrictive versus liberal fluid therapy in geriatric patients undergoing major abdominal surgery: a randomized controlled trial

In geriatric patients undergoing major abdominal surgery, a liberal fluid regimen was associated with a lower rate of AKI and postoperative infection than restrictive fluid regimen and did not increase the risk of postoperative complications.

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection, but increased kidney injury was also observed in restrictive fluid Therapy.

Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials

GDFT in major non- cardiac surgical patients has questionable benefit over a standard care in terms of postoperative mortality, length of hospital stay and length of ICU stay, but incidence of all complications including wound infection, abdominal complications and postoperative hypotension is reduced.

Contemporary Approaches to Perioperative IV Fluid Therapy

There is good evidence supporting the avoidance of unnecessary fasting and the value of an individualized perioperative IV fluid regimen, with transition to oral fluids as soon as possible, to help patients recover from major surgery.

Clinical and economic impact of goal-directed fluid therapy during elective gastrointestinal surgery

In patients undergoing gastrointestinal surgery, the implementation of a GDFT protocol was associated with a reduction in postoperative morbidity without increasing costs.
...

References

SHOWING 1-10 OF 75 REFERENCES

Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study

A liberal compared to a restrictive intravascular fluid regimen may lead to significant hypercoagulability and a reduction in vomiting, but without differences in other recovery variables or hospital stay after fast-track knee arthroplasty.

Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study.

A 'restrictive' fluid regimen led to a transient improvement in pulmonary function and postoperative hypoxaemia but no other differences in all-over physiological recovery compared with a 'liberal' [corrected] fluid regimen after fast-track colonic surgery.

Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures.

Invasive intraoperative haemodynamic monitoring with fluid challenges during repair of femoral fracture under general anaesthetic shortens time to being medically fit for discharge, and postoperative recovery for survivors was significantly faster.

Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.

Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial.

The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.

Liberal Versus Restrictive Fluid Administration to Improve Recovery After Laparoscopic Cholecystectomy: A Randomized, Double-Blind Study

Nausea, general well-being, thirst, dizziness, drowsiness, fatigue, and balance function were significantly improved, as well as significantly more patients fulfilled discharge criteria and were discharged on the day of surgery with the high-volume fluid substitution.

Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial

Restricted postoperative IV fluid management, as performed in this trial, in patients undergoing major abdominal surgery appears harmful as it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital stay.

Meta-analysis of hemodynamic optimization in high-risk patients*

Review of 21 randomized controlled trials with various approaches to treatment revealed statistically significant mortality reductions, with hemodynamic optimization, when patients with acute critical illness were treated early to achieve optimal goals before the development of organ failure, when there were control group mortalities of >20% and when therapy produced differences in oxygen delivery between the control and protocol groups.

Preliminary Results of a Prospective Randomized Trial of Restrictive Versus Standard Fluid Regime in Elective Open Abdominal Aortic Aneurysm Repair

Serious complications are common after elective open AAA repair, and it is shown for the first time that a restricted perioperative fluid regimen can prevent MC and significantly reduce overall hospital stay.

Fluid Management for Laparoscopic Colectomy: A Prospective, Randomized Assessment of Goal-Directed Administration of Balanced Salt Solution or Hetastarch Coupled with an Enhanced Recovery Program

Goal-directed, individualized intraoperative fluid management with crystalloid should be evaluated further as a component of enhanced recovery protocols following colectomy because of reduced overall fluid administration.
...