Goal directed fluid therapy for major liver resection: A multicentre randomized controlled trial

Area of Science:

• Hepatobiliary Surgery
• Critical Care Medicine
• Perioperative Fluid Management

Background:

• The impact of restrictive goal-directed therapy (GDT) fluid protocols combined with enhanced recovery after surgery (ERAS) on hospital stay after major liver resection remains unclear.
• Optimizing fluid management is crucial in major abdominal surgeries to minimize complications and improve patient outcomes.

Purpose of the Study:

• To evaluate if a patient-specific, surgery-specific intraoperative restrictive fluid optimization algorithm can reduce hospital stay and perioperative fluid-related complications.
• To assess the efficacy of a restrictive fluid protocol within an ERAS framework for major liver resection patients.

Main Methods:

• A multicenter randomized controlled pilot trial was conducted.
• Participants were assigned to either a restrictive fluid optimization algorithm group or a conventional care group.
• Intraoperative fluid balances and volumes were meticulously recorded.

Main Results:

• Forty-eight participants were enrolled; no statistically significant difference in median hospital stay was observed between groups (7.0 vs. 8.0 days).
• The restrictive group exhibited lower intraoperative fluid balances (808 mL vs. 1345 mL) and received less fluid per kg/hour (4.3 mL/kg/hr vs. 6.0 mL/kg/hr).
• No significant differences in complications or need for vasoactive drugs were found between the groups.

Conclusions:

• In high-volume hepatobiliary centers, adding a fluid restrictive cardiac output-guided algorithm to a standard ERAS protocol did not significantly decrease hospital stay or fluid-related complications.
• The study's findings are hypothesis-generating, suggesting a larger confirmatory trial may be beneficial.