Excessive Fluid Restriction Holds Risk in Major Abdominal Surgery

Restricting fluids excessively during major abdominal surgery increases the risk of hypovolemia and impairs organ function after surgery; suggest the results of a new study.

Researchers at the University Hospital of Clermont-Ferrand (France) conducted a prospective randomized trial to compare the influence of two volumes of fluid, integrated with goal-directed fluid therapy, on hypovolemia and central venous oxygen saturation (ScvO2), and to assess their relationships with postoperative morbidity. To do so, 70 consecutive patients undergoing major abdominal surgery were randomly assigned to either restrictive fluid strategy of 6 mL/kg/h of crystalloid, or to a more conservative fluid strategy of 12 mL/kg/h of crystalloid. In both groups, a fluid bolus was administered when respiratory variation in peak aortic flow velocity (PV) was greater than 13%. Data on hypovolemia, ScvO2, and postoperative complications were recorded for all patients.

The results showed that the overall incidence of complications, including postoperative anastomotic leak and sepsis, was higher in the restrictive group than in the conservative group. The number of patients with hypovolemia also increased significantly in the restrictive group when compared with the conservative group. The perioperative mean ScvO2 and mean minimum ScvO2 were also significantly lower in the restrictive group than in the conservative grouping. Multivariate analysis showed that both hypovolemia and mean minimum ScvO2 were independently associated with anastomotic leak and sepsis. The study was published in the December 2011 issue of Archives of Surgery.

"Optimization of intravascular volume is a prerequisite to adequate tissue perfusion, and early detection and correction of potential tissue hypoxia triggers such as hypovolemia are fundamentally important,” concluded lead author Emmanuel Futier, MD, and colleagues of the department of anesthesiology and critical care medicine. "Excessively restrictive fluid strategies, particularly if unmonitored fixed regimens are used, should be applied cautiously to surgical patients.”

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University Hospital of Clermont-Ferrand