title: Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial.
abstract: OBJECTIVE
  To compare the influence of 2 volumes of fluid, integrated with goal-directed fluid therapy, on hypovolemia (a key trigger of tissue hypoperfusion) and central venous oxygen saturation (Scvo₂) and to assess their relationships with postoperative morbidity.
  
  
  METHODS
  A prospective, randomized trial of 70 consecutive patients undergoing major abdominal surgery.
  
  
  METHODS
  Patients were randomly assigned to 6 mL/kg/h of crystalloid (a restrictive fluid strategy) or 12 mL/kg/h of crystalloid (a more conservative fluid strategy). In both groups, a fluid bolus was administered when respiratory variation in peak aortic flow velocity (ΔPV) was greater than 13%. Data on hypovolemia (ΔPV > 13%), Scvo₂, and postoperative complications were recorded for all patients.
  
  
  METHODS
  Overall incidence of postoperative complications, especially anastomotic leak and sepsis.
  
  
  RESULTS
  Overall incidence of complications, including postoperative anastomotic leak and sepsis, was higher in the restrictive group than in the conservative group (all P < .05). The number of patients with hypovolemia increased significantly in the restrictive group compared with the conservative group (P < .001). The perioperative mean Scvo₂ (P = .02) and mean minimum Scvo₂ (P = .04) were significantly lower in the restrictive group than in the conservative group. Multivariate analysis showed that both hypovolemia and mean minimum Scvo₂ were independently associated with anastomotic leak and sepsis.
  
  
  CONCLUSIONS
  Excessive fluid restriction increased the level of hypovolemia, leading to reduced Scvo₂ and thereby increased incidence of postoperative complications. Excessive fluid restriction should be applied cautiously in surgical patients.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00852449.
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of Clermont-Ferrand, France. efutier@chu-clermontferrand.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.forename: Antoine
authors.initials: A
authors.lastname: Petit
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.forename: Fabrice
authors.initials: F
authors.lastname: Kwiatkowski
authors.forename: Renaud
authors.initials: R
authors.lastname: Flamein
authors.forename: Karem
authors.initials: K
authors.lastname: Slim
authors.forename: Vincent
authors.initials: V
authors.lastname: Sapin
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Jean-Etienne
authors.initials: JE
authors.lastname: Bazin
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002496:Central Venous Pressure; D016001:Confidence Intervals; D000077324:Crystalloid Solutions; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000592:standards; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D020896:Hypovolemia / Q000517:prevention & control; D007430:Intraoperative Care / Q000379:methods*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010100:Oxygen