title: Fluid management during video-assisted thoracoscopic surgery for lung resection: a randomized, controlled trial of effects on urinary output and postoperative renal function.
abstract: BACKGROUND
  Increased perioperative fluid administration is an independent risk factor for lung injury after pulmonary resection. In clinical practice, fluid therapy is heavily guided by urinary output; however, diuretic response to plasma volume expansion has been reported to be blunted during anesthesia and surgery. We therefore hypothesized that in patients undergoing video-assisted thoracoscopic surgery, different regimens of intraoperative fluid management would not affect urinary output as would be expected in the nonsurgical scenario. Moreover, a restrictive perioperative fluid approach, as indicated in these operations, will not harm renal function.
  
  
  METHODS
  One hundred two patients undergoing video-assisted thoracoscopic surgery were randomly allocated to receive intraoperatively either high (8 mL/[kg · h]; n = 51) or low (2 mL/[kg · h]; n = 51) amounts of Ringer's lactate solution. The primary end point was intraoperative urinary output. Secondary end points included postoperative creatinine serum levels and postoperative complication rate.
  
  
  RESULTS
  Demographic and surgical data were comparable between groups. Regardless of the intraoperatively fluids administered (mean ± SD, 2131 ± 850 vs 1035 ± 652 mL in high and low groups, respectively; P < .0001), urinary output was similar (median 300 mL). Perioperative creatinine serum levels decreased significantly postoperatively and were not significantly different among the groups.
  
  
  CONCLUSIONS
  In patients undergoing video-assisted thoracoscopic surgery, intraoperative urinary output and postoperative renal function are not affected by administration of fluids in the range of 2 to 8 mL/(kg · h). The clinical practice of administering fluids to enhance diuresis in the perioperative period should therefore be abandoned.
authors.affiliation: Department of Anesthesiology, Pain, and Intensive Care, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. iditm@tlvmc.gov.il
authors.forename: Idit
authors.initials: I
authors.lastname: Matot
authors.forename: Elia
authors.initials: E
authors.lastname: Dery
authors.forename: Yuri
authors.initials: Y
authors.lastname: Bulgov
authors.forename: Barak
authors.initials: B
authors.lastname: Cohen
authors.forename: Joseph
authors.initials: J
authors.lastname: Paz
authors.forename: Nachum
authors.initials: N
authors.lastname: Nesher
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007430:Intraoperative Care; D007552:Isotonic Solutions / Q000008:administration & dosage*; D007557:Israel; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D000077325:Ringer's Lactate; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014554:Urination; D014882:Water-Electrolyte Balance
chemical_list: D015415:Biomarkers; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D003404:Creatinine
keywords: 1; 10.4; 41.2; 41.3; ASA; American Society of Anesthesiologists; POD; RL; Ringer's lactate solution; VATS; postoperative day; video-assisted thoracoscopic surgery