title: Using clinical parameters to guide fluid therapy in high-risk thoracic surgery. A retrospective, observational study.
abstract: BACKGROUND
  Despite extensive research, the debate continues as to the optimal way of guiding intraoperative and postoperative fluid therapy. In 2009 we changed our institutional guideline for perioperative fluid therapy in patients undergoing extrapleural pneumonectomy (EPP) and implemented the use of central venous oxygen saturation and intended low urine output to guide therapy in the early postoperative period. Here we evaluate the consequences of our changes.
  
  
  METHODS
  Retrospective, observational study of 30 consecutive patients undergoing EPP; 18 who had surgery before and 12 who had surgery after the changes. Data were collected from patient files and from institutional databases. Outcome measures included: Volumes of administered fluids, fluid balances, length of stays and postoperative complications. Dichotomous variables were compared with Fisher's exact test, whereas continuous variables were compared with Student's unpaired t-test or the Wilcoxon Two-Sample Test depending on the distribution of data.
  
  
  RESULTS
  The applied changes significantly reduced the volumes of administered fluids, both in the intraoperative (p = 0.01) and the postoperative period (p = 0.04), without increasing the incidence of postoperative complications. Mean length of stay in the intensive care unit (LOSI) was reduced from three to one day (p = 0.04) after the changes.
  
  
  CONCLUSIONS
  The use of clinical parameters to balance fluid restriction and a sufficient circulation in patients undergoing EPP was associated with a reduction in mean LOSI without increasing the incidence of postoperative complications. Due to methodological limitations these results are only hypothesis generating.
authors.affiliation: Section for Surgical Pathophysiology & Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. lars.stryhn.bjerregaard@regionh.dk.
authors.forename: Lars Stryhn
authors.initials: LS
authors.lastname: Bjerregaard
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. hassedk@gmail.com.
authors.forename: Hasse
authors.initials: H
authors.lastname: Møller-Sørensen
authors.affiliation: Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. lindskov@gmail.com.
authors.forename: Kristoffer Lindskov
authors.initials: KL
authors.lastname: Hansen
authors.affiliation: Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. jesper.ravn@regionh.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Ravn
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. jens.christian.nilsson@regionh.dk.
authors.forename: Jens Christian
authors.initials: JC
authors.lastname: Nilsson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014556:Urine / Q000502:physiology
chemical_list: D010100:Oxygen