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A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative Fluid Management Strategy Compared With
Rachael L Parke1,2,3,4, Eileen Gilder1,2, Michael J Gillham1
1Cardiothoracic and Vascular ICU, Auckland City Hospital, Auckland, New Zealand.
Critical Care Medicine
|January 29, 2021
Summary
A protocol to guide fluid administration in cardiac surgery patients reduced fluid intake but did not shorten ICU stays. This strategy, however, was associated with increased hospital mortality.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Fluid Management
Background:
- Limited evidence exists for optimal fluid administration in ICU patients post-cardiac surgery.
- Fluid management strategies significantly impact patient outcomes in intensive care settings.
Purpose of the Study:
- To evaluate if a protocolized fluid administration strategy reduces ICU length of stay in cardiac surgery patients.
- To compare a stroke volume variation-guided fluid strategy against usual care.
Main Methods:
- A prospective, multicenter, randomized clinical trial involving 715 cardiac surgery patients.
- Intervention group received protocol-guided fluid administration using stroke volume variation.
- Control group received usual care fluid administration for up to 24 hours.
Main Results:
- The protocol group received significantly less bolus fluid and had a lower overall fluid balance.
- No significant difference was observed in ICU length of stay between the groups.
- Hospital mortality was higher in the intervention group (4%) compared to the usual care group (1.4%).
Conclusions:
- A protocol-guided fluid strategy reduced fluid administration but did not decrease ICU length of stay.
- The studied fluid management protocol did not improve other key outcomes like organ dysfunction or disability-free survival.
- Higher hospital mortality in the intervention group warrants careful consideration of this strategy.
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