Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial

Area of Science:

• Critical Care Medicine
• Surgical Oncology
• Gastroenterology

Background:

• Major complications occur in over 50% of patients undergoing emergency gastrointestinal surgery.
• Intravenous (i.v.) fluid therapy is crucial, but optimal strategies remain unclear.
• This study investigated goal-directed fluid therapy (GDT) versus standard i.v. fluid therapy (STD) in this patient population.

Purpose of the Study:

• To determine if goal-directed fluid therapy (GDT) reduces major complications or death in patients undergoing emergency gastrointestinal surgery compared to standard i.v. fluid therapy (STD).

Main Methods:

• A randomized, assessor-blinded, multicenter trial included 312 adult patients with gastrointestinal obstruction or perforation.
• The GDT group received i.v. fluid targeting near-maximal stroke volume, while the STD group received fluid per best clinical practice.
• The primary outcome was a composite of major complications or death within 90 days.

Main Results:

• No significant difference in the primary outcome was observed between the GDT and STD groups (30% vs 25%, P=0.40).
• Hospital stay was longer in the GDT group (median 7 days) compared to the STD group (median 6 days, P=0.04).
• No other significant differences in secondary outcomes were found between the groups.

Conclusions:

• Flow-guided fluid therapy to near-maximal stroke volume (GDT) did not improve outcomes after surgery for bowel obstruction or gastrointestinal perforation.
• GDT may potentially prolong hospital stay compared to standard i.v. fluid therapy.
• Current evidence does not support GDT over standard fluid management for reducing complications in this surgical setting.