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

Vermeulen, Hester; Hofland, Jan; Legemate, Dink A.; Ubbink, Dirk T.

doi:10.1186/1745-6215-10-50

Cited by 64 publications

(71 citation statements)

References 31 publications

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“…Although this is in excess of maintenance requirements, some studies have considered this to be a 'standard' fluid regimen (27) . Some studies using 'restricted' fluid regimens have provided patients with appropriate maintenance requirements (27,28) , while others have used true restriction and given patients less than the desired amount (29,30) . In addition, there is often a discrepancy between the amount of fluid prescribed and that delivered.…”

Section: Definitionsmentioning

confidence: 99%

“…Nine studies (27)(28)(29)(30)(33)(34)(35)(36)(37) with a total of 801 patients met the inclusion criteria for the primary analysis. The characteristics of the studies are summarised in Table 1.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…All studies except one (34) reported a 30-d followup period. Only two studies (29,30) were performed in a double-blind manner. Two were unblinded (27,36) and the rest (28,(33)(34)(35)37) were reported as observer-blinded.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…7 (range 3-5), indicating moderate methodological quality. All studies involved a consecutive series of patients using appropriate randomisation methods, including computer-generated randomisation numbers in four (28,29,33,34) , the sealed envelope method in four (27,30,36,37) and telephone randomisation in Proceedings of the Nutrition Society one (35) . All studies except one (34) reported a 30-d followup period.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

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A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

2010

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The terminology used for describing intervention groups in randomised controlled trials (RCT) on the effect of intravenous fluid on outcome in abdominal surgery has been imprecise, and the lack of standardised definitions of the terms 'standard', 'restricted' and 'liberal' has led to some confusion and difficulty in interpreting the literature. The aims of this paper were to clarify these definitions and to use them to perform a meta-analysis of nine RCT on primarily crystalloid-based peri-operative intravenous fluid therapy in 801 patients undergoing elective open abdominal surgery. Patients who received more or less fluids than those who received a 'balanced' amount were considered to be in a state of 'fluid imbalance'. When 'restricted' fluid regimens were compared with 'standard or liberal' fluid regimens, there was no difference in post-operative complication rates (risk ratio 0 . 96 (95 % CI 0 . 56, 1 . 65), P = 0 . 89) or length of hospital stay (weighted mean difference (WMD) -1 . 77 (95% CI -4 . 36, 0 . 81) d, P = 0 . 18). However, when the fluid regimens were reclassified and patients were grouped into those who were managed in a state of fluid 'balance' or 'imbalance', the former group had significantly fewer complications (risk ratio 0 . 59 (95 % CI 0 . 44, 0 . 81), P = 0 . 0008) and a shorter length of stay (WMD -3 . 44 (95 % CI -6 . 33, -0 . 54) d, P = 0 . 02) than the latter. Using imprecise terminology, there was no apparent difference between the effects of fluid-restricted and standard or liberal fluid regimens on outcome in patients undergoing elective open abdominal surgery. However, patients managed in a state of fluid balance fared better than those managed in a state of fluid imbalance.

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Section: Definitionsmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

See 2 more Smart Citations

A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

2010

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“…However, some disadvantages of the abdominal model linger, such as abdominal infection, postoperative paralysis of the hind limbs, difficulty handling lumbar vessels, and time limitations associated with obstructing the recipient's blood flow. Moreover, the relatively large area exposed during abdominal surgery elicits fluid loss, 5 and use of ice-cold saline solution in the abdomen during vascular anastomosis can decrease body temperature.…”

Section: Introductionmentioning

confidence: 99%

Introduction of Modified Cervical Cardiac Transplant Model in Mice

Gong¹,

Thornley²,

Whitcher³

et al. 2012

Exp Clin Transplant

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Objectives: The murine cervical heterotopic heart transplant model was initially designed to test the immune response to third-party allografts, modified by cuff techniques. While cuff techniques simplify the execution of this procedure, cutting of the carotid artery and the external jugular vein alters the blood supply to central nervous system and makes it difficult to achieve long-term graft survival. In the present study, we describe modified techniques that preserve the continuity and function of blood vessels and improve transplant integrity. Materials and Methods:The modified techniques in this study comprise the following aspects: (1) Preservation of the sternal head of the right sternocleidomastoid muscle, (2) use of the donor's intrathoracic inferior vena cava for anastomosis and (3) preservation of the function of the recipient's carotid artery and external jugular vein and thus, continuity of blood flow to the central nervous system. Results: Stable, long-term, disease-free allograft survival has been achieved with syngeneic transplants (> 200 days), whereas allografts from fully major histocompatibility complex-mismatched donors were acutely rejected in a time similar to the traditional abdominal heterotopic heart transplant model (8.2 ± 1.3 vs 8.4 ± 1.4 days; P = .73 in the Mantel Cox test, and P = .61 in the Gehan-BreslowWilcoxon test). Similar alloresponses could be induced in these 2 models. Conclusions: It is possible and feasible to achieve long-term graft survival in the mouse cervical heart transplant model using the modified procedures described in the present study.

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Randomized clinical trial of fluid and salt restriction compared with a controlled liberal regimen in elective gastrointestinal surgery

Kalyan

Rosbergen

Pal

et al. 2013

British Journal of Surgery

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BackgroundExcessive intravenous fluid prescription may play a causal role in postoperative complications following major gastrointestinal resectional surgery. The aim of this study was to investigate whether fluid and salt restriction would decrease postoperative complications compared with a more modern controlled liberal regimen.MethodsIn this observer-blinded single-site randomized clinical trial consecutive patients undergoing major gastrointestinal resectional surgery were randomized to receive either a liberal control fluid regimen or a restricted fluid and salt regimen. The primary outcome was postoperative complications of grade II and above (moderate to severe).ResultsSome 240 patients (194 colorectal resections and 46 oesophagogastric resections) were enrolled in the study; 121 patients were randomized to the restricted regimen and 119 to the control (liberal) regimen. During surgery the control group received a median (interquartile range) fluid volume of 2033 (1576–2500) ml and sodium input of 282 (213–339) mmol, compared with 1000 (690–1500) ml and 142 (93–218) mmol respectively in the restricted group. There was no significant difference in major complication rate between groups (38·0 and 39·0 per cent respectively). Median (range) hospital stay was 8 (3–101) days in the controls and 8 (range 3–76) days among those who received restricted fluids. There were four in-hospital deaths in the control group and two in the restricted group. Substantial differences in weight change, serum sodium, osmolality and urine : serum osmolality ratio were observed between the groups.ConclusionThere were no significant differences in major complication rates, length of stay and in-hospital deaths when fluid restriction was used compared with a more liberal regimen. Registration number: ISRCTN39295230 (http://www.controlled-trials.com).

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

Cited by 64 publications

References 31 publications

A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

Introduction of Modified Cervical Cardiac Transplant Model in Mice

Randomized clinical trial of fluid and salt restriction compared with a controlled liberal regimen in elective gastrointestinal surgery

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