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

被引:286
作者
Corcoran, Tomas [1 ]
Rhodes, Julia Emma Joy [1 ]
Clarke, Sarah [2 ]
Myles, Paul S. [3 ,4 ]
Ho, Kwok M. [5 ,6 ]
机构
[1] Royal Perth Hosp, Dept Anaesthesia & Pain Med, Perth, WA 6000, Australia
[2] Royal Perth Hosp, Dept Emergency Med, Perth, WA 6000, Australia
[3] Alfred Hosp, Dept Anaesthesia & Perioperat Med, Melbourne, Vic, Australia
[4] Monash Univ, Melbourne, Vic 3004, Australia
[5] Royal Perth Hosp, Dept Intens Care Med, Perth, WA 6000, Australia
[6] Univ Western Australia, Sch Populat Hlth, Perth, WA 6009, Australia
关键词
RANDOMIZED CONTROLLED-TRIAL; RISK SURGICAL-PATIENTS; PERIPHERAL VASCULAR-SURGERY; ESOPHAGEAL DOPPLER MONITOR; FAST-TRACK SURGERY; HOSPITAL STAY; CLINICAL-TRIAL; PREOPERATIVE OPTIMIZATION; REDUCES COMPLICATIONS; ABDOMINAL-SURGERY;
D O I
10.1213/ANE.0b013e318240d6eb
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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 register without language restrictions. Indirect comparison between the GD and LVR strata was performed. RESULTS: A total of 3861 patients from 23 GD RCTs (median sample size = 90, interquartile range [IQR] 57 to 109) and 1160 patients from 12 LVR RCTs (median sample size = 80, IQR36 to 151) were considered. Both liberal and GD therapy used more fluid compared to their respective comparative arm, but their effects on outcomes were very different. Patients in the liberal group of the LVR stratum had a higher risk of pneumonia (risk ratio [RR] 2.2, 95% confidence interval [CI] 1.0 to 4.5), pulmonary edema (RR 3.8, 95% CI 1.1 to 13), and a longer hospital stay than those in the restrictive group (mean difference [MD] 2 days, 95% CI 0.5 to 3.4). Using GD therapy also resulted in a lower risk of pneumonia (RR 0.7, 95% CI 0.6 to 0.9) and renal complications (0.7, 95% CI 0.5 to 0.9), and a shorter length of hospital stay (MD 2 days, 95% CI 1 to 3) compared to not using GD therapy. Liberal fluid therapy was associated with an increased length of hospital stay (4 days, 95% CI 3.4 to 4.4), time to first bowel movement (2 days, 95% CI 1.3 to 2.3), and risk of pneumonia (RR ratio 3, 95% CI 1.8 to 4.8) compared to GD therapy. CONCLUSION: Perioperative outcomes favored a GD therapy rather than liberal fluid therapy without hemodynamic goals. Whether GD therapy is superior to a restrictive fluid strategy remains uncertain. (Anesth Analg 2012;114:640-51)
引用
收藏
页码:640 / 651
页数:12
相关论文
共 70 条
[21]   Effect of Postoperative Restrictive Fluid Therapy in the Recovery of Patients with Abdominal Vascular Surgery [J].
Gonzalez-Fajardo, J. A. ;
Mengibar, L. ;
Brizuela, J. A. ;
Castrodeza, J. ;
Vaquero-Puerta, C. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2009, 37 (05) :538-543
[22]   ESTIMATION OF A COMMON EFFECT PARAMETER FROM SPARSE FOLLOW-UP DATA [J].
GREENLAND, S ;
ROBINS, JM .
BIOMETRICS, 1985, 41 (01) :55-68
[23]  
Harten J, 2008, Int J Surg, V6, P197, DOI 10.1016/j.ijsu.2008.03.002
[24]   The Efficacy and Safety of Colloid Resuscitation in the Critically III [J].
Hartog, Christiane S. ;
Bauer, Michael ;
Reinhart, Konrad .
ANESTHESIA AND ANALGESIA, 2011, 112 (01) :156-164
[25]   Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study [J].
Holte, K. ;
Foss, N. B. ;
Andersen, J. ;
Valentiner, L. ;
Lund, C. ;
Bie, P. ;
Kehlet, H. .
BRITISH JOURNAL OF ANAESTHESIA, 2007, 99 (04) :500-508
[26]   Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy - A randomized, double-blind study [J].
Holte, K ;
Klarskov, B ;
Christensen, DS ;
Lund, C ;
Nielsen, KG ;
Bie, P ;
Kehlet, H .
ANNALS OF SURGERY, 2004, 240 (05) :892-899
[27]   Liberal versus restrictive fluid management in knee arthroplasty: A randomized, double-blind study [J].
Holte, Kathrine ;
Kristensen, Billy B. ;
Valentiner, Lotte ;
Foss, Nicolai B. ;
Husted, Henrik ;
Kehlet, Henrik .
ANESTHESIA AND ANALGESIA, 2007, 105 (02) :465-474
[28]   Fluid therapy and surgical outcomes in elective surgery: A need for reassessment in fast-track surgery [J].
Holte, Kathrine ;
Kehlet, Henrik .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2006, 202 (06) :971-989
[29]   Estimating the mean and variance from the median, range, and the size of a sample [J].
Hozo S.P. ;
Djulbegovic B. ;
Hozo I. .
BMC Medical Research Methodology, 5 (1)
[30]  
Hubner M, 2010, J SURG RES 0927