Fluid management during video-assisted thoracoscopic surgery for lung resection: A randomized, controlled trial of effects on urinary output and postoperative renal function

Matot, Idit; Dery, Elia; Bulgov, Yuri; Cohen, Barak; Paz, Joseph; Nesher, Nahum

doi:10.1016/j.jtcvs.2013.02.015

Cited by 60 publications

(39 citation statements)

References 21 publications

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“…Understandably, given the absence of trials primarily investigating the effects of urine output as a target, to account for all the possible sources of heterogeneity within the currently available literature would be impractical and the inability to do so is currently an inevitable limitation. However, after acknowledging this limitation, our findings are currently the only assessment of the effects of targeting urine output on mortality, and are supported by the observations from various trials [ 6 , 59 ].…”

Section: Discussionsupporting

confidence: 71%

“…However, a suboptimal hemodynamic status is not always the cause of oliguria. In recent years, the concept of an association between intraoperative urine output and postoperative acute kidney injury has been challenged [ 4 – 6 ]. As a result, advocacy for permissive oliguria has increased, for example to include permissive oliguria in the early recovery after surgery (ERAS) protocols [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Targeting urine output and 30-day mortality in goal-directed therapy: a systematic review with meta-analysis and meta-regression

et al. 2017

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BackgroundOliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care.MethodsWe performed a systematic review with a random-effects meta-analyses and meta-regression based on search strategy through MEDLINE, EMBASE and references in relevant articles. We included studies comparing conventional fluid management with goal-directed therapy and reporting whether urine output was used as target or not, and reporting 30-day mortality data in perioperative and critical care.ResultsWe found 36 studies in which goal-directed therapy reduced 30-day mortality (OR 0.825; 95% CI 0.684-0.995; P = 0.045). Targeting urine output within goal-directed therapy increased 30-day mortality (OR 2.66; 95% CI 1.06-6.67; P = 0.037), but not in conventional fluid management (OR 1.77; 95% CI 0.59-5.34; P = 0.305). After adjusting for operative setting, hemodynamic monitoring device, underlying etiology, use of vasoactive medication and year of publication, we found insufficient evidence to associate targeting urine output with a change in 30-day mortality (goal-directed therapy: OR 1.17; 95% CI 0.54-2.56; P = 0.685; conventional fluid management: OR 0.74; 95% CI 0.39-1.38; P = 0.334).ConclusionsThe principal finding of this meta-analysis is that after adjusting for confounders, there is insufficient evidence to associate targeting urine output with an effect on 30-day mortality. The paucity of direct data illustrates the need for further research on whether permissive oliguria should be a key component of fluid management protocols.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0316-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Targeting urine output and 30-day mortality in goal-directed therapy: a systematic review with meta-analysis and meta-regression

et al. 2017

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“…Sachin's study demonstrated that intraoperative urine output was not an independent predictor of acute renal failure for non-cardiac surgery patients whose previous renal function was normal (14). Similarly, in VATS lung resection patients, a study found that intraoperative urinary output and postoperative renal function were not affected by the administration of fluids (15). Thus, except in patients with previously abnormal renal function or for whom fluid management is crucial, such as pneumonectomy, placing a urinary catheter to monitor perioperative urine output is not recommended (11).…”

Section: Discussionmentioning

confidence: 99%

A Novel Tubeless Urinary Catheter Protocol Enhanced Recovery After Minimally Invasive Lung Surgery

et al. 2020

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Objectives: Although previous studies have shown the feasibility of non-intubated techniques, it is unknown whether avoiding urinary catheters can enhance recovery. This study aimed to determine whether the tubeless urinary catheter protocol is feasible and beneficial for minimally invasive lung surgery. Methods: Patients were randomized to the control group, completely tubeless group, and partially tubeless group. A propensity score–matched (PSM) analysis was performed to balance the non-random baseline characteristics. Complications and postoperative recovery were compared. Regression analysis was performed to identify the independent predictors of complications. A nomogram for predicting the risk of non-automatic micturition was constructed and internally validated. Results: One hundred fifty-nine patients were enrolled. The incidence rates of urinary irritation and urinary tract infection (UTI) were significantly lower in the tubeless groups (74.4 vs. 39.5%, p < 0.001; 28.2 vs. 8.6%, p = 0.001, respectively). The tubeless group had a higher proportion of 0-degree discomfort (81.5 vs. 30.8%, p = 0.001) and shorter duration of postoperative hospital stay than the control group (4.59 vs. 5.53 days, p < 0.001). No difference was observed in terms of urination retention and urinary incontinence between the tubeless group and the control group. After PSM, the advantages of the tubeless group still existed, and comparing to the partially tubeless group, the completely tubeless group was of even less UTI and more 0-degree discomfort (18.5 vs. 0.0%, p = 0.019; 96.3 vs. 59.3%, p = 0.002). The tubeless protocol was the only independent protective factor of urinary complications. A nomogram was constructed and showed good predictive ability. Conclusions: The tubeless catheterization protocol led to fewer complications, better compliance, and shorter hospital length of stay. The advantages were more significant with the completely tubeless protocol. The utility of our nomogram can assist clinicians in avoiding risks in performing the tubeless protocol.

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“…Excessive fluid overload is a key factor leading to pulmonary edema and lung injury (30). Shedding of the endothelial glycocalyx in response to atrial natriuretic peptide release brought on by hypervolemia and mechanotransduction of the glycocalyx in response to capillary shear stress may be some of the underlying mechanisms to explain the harmful effects of overhydration (31).…”

Section: Eg and Overhydrationmentioning

confidence: 99%

The Endothelial Glycocalyx and One-Lung Ventilation Induced Lung Injury—New Focus

Yin¹,

Wang²,

Xia³

2016

J Anesth Perioper Med

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Fluid management during video-assisted thoracoscopic surgery for lung resection: A randomized, controlled trial of effects on urinary output and postoperative renal function

Cited by 60 publications

References 21 publications

Targeting urine output and 30-day mortality in goal-directed therapy: a systematic review with meta-analysis and meta-regression

Targeting urine output and 30-day mortality in goal-directed therapy: a systematic review with meta-analysis and meta-regression

A Novel Tubeless Urinary Catheter Protocol Enhanced Recovery After Minimally Invasive Lung Surgery

The Endothelial Glycocalyx and One-Lung Ventilation Induced Lung Injury—New Focus

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