Weinberg Laurence, Ianno Damian, Churilov Leonid, Mcguigan Steven, Mackley Lois, Banting Jonathan, Shen Shi Hong, Riedel Bernhard, Nikfarjam Mehrdad, Christophi Chris
Director of Anesthesia, Austin Hospital; and A/Professor, Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia.
Department of Anesthesia, Austin Health, Victoria, Australia.
Ann Med Surg (Lond). 2019 Jul 10;45:45-53. doi: 10.1016/j.amsu.2019.07.003. eCollection 2019 Sep.
The effect a restrictive goal directed therapy (GDT) fluid protocol combined with an enhanced recovery after surgery (ERAS) programme on hospital stay for patients undergoing major liver resection is unknown.
We conducted a multicentre randomized controlled pilot trial evaluating whether a patient-specific, surgery-specific intraoperative restrictive fluid optimization algorithm would improve duration of hospital stay and reduce perioperative fluid related complications.
Forty-eight participants were enrolled. The median (IQR) length of hospital stay was 7.0 days (7.0:8.0) days in the restrictive fluid optimization algorithm group (Restrict group) vs. 8.0 days (6.0:10.0) in the conventional care group (Conventional group) (Incidence rate ratio 0.85; 95% Confidence Interval 0.71:1.1; p = 0.17). No statistically significant difference in expected number of complications per patient between groups was identified (IRR 0.85; 95%CI: 0.45-1.60; p = 0.60). Patients in the Restrict group had lower intraoperative fluid balances: 808 mL (571:1565) vs. 1345 mL (900:1983) (p = 0.04) and received a lower volume of fluid per kg/hour intraoperatively: 4.3 mL/kg/hr (2.6:5.8) vs. 6.0 mL/kg/hr (4.2:7.6); p = 0.03. No significant differences in the proportion of patients who received vasoactive drugs intraoperatively (p = 0.56) was observed.
In high-volume hepatobiliary surgical units, the addition of a fluid restrictive intraoperative cardiac output-guided algorithm, combined with a standard ERAS protocol did not significantly reduce length of hospital stay or fluid related complications. Our findings are hypothesis-generating and a larger confirmatory study may be justified.
限制性目标导向液体治疗（GDT）方案联合术后加速康复（ERAS）计划对接受大肝切除术患者住院时间的影响尚不清楚。
我们进行了一项多中心随机对照试验，评估针对患者和手术的术中限制性液体优化算法是否会缩短住院时间并减少围手术期液体相关并发症。
共纳入48名参与者。限制性液体优化算法组（限制组）的中位（IQR）住院时间为7.0天（7.0:8.0），而传统护理组（传统组）为8.0天（6.0:10.0）（发病率比0.85；95%置信区间0.71:1.1；p = 0.17）。两组间每位患者预期并发症数量无统计学显著差异（IRR 0.85；95%CI：0.45 - 1.60；p = 0.60）。限制组患者术中液体平衡较低：808 mL（571:1565）对比1345 mL（900:1983）（p = 0.04），且术中每千克每小时接受的液体量较低：4.3 mL/kg/hr（2.6:5.8）对比6.0 mL/kg/hr（4.2:7.6）；p = 0.0三。术中接受血管活性药物的患者比例无显著差异（p = 0.56）。
在大容量肝胆外科手术科室，添加限制性液体术中心输出量导向算法并结合标准ERAS方案并未显著缩短住院时间或减少液体相关并发症。我们的研究结果具有启发性，可能有必要进行更大规模的验证性研究。
