Translating evidence into practice: still a way to go

Area of Science:

• Anesthesiology and Perioperative Medicine
• Nephrology
• Surgical Outcomes Research

Background:

• Retrospective analysis of 32,250 patients undergoing elective abdominal surgery (2015-2019) from the Multicenter Perioperative Outcomes Group (MPOG) database.
• Investigated trends in intraoperative fluid and vasopressor administration and their association with acute kidney injury (AKI).

Discussion:

• Findings align with the RELIEF trial, suggesting restrictive fluid strategies may be beneficial.
• Highlights the complex interplay between crystalloid volume, arterial pressure, and AKI risk.
• Identifies a significant increase in AKI risk with higher intraoperative vasopressor use (norepinephrine equivalents).

Key Insights:

• Lowest AKI risk predicted with crystalloid administration between 15-20 ml kg^-1 h^-1.
• An 80% increased AKI risk observed with vasopressor use rising from 0 to 0.04 μg kg^-1 min^-1.
• Mean intraoperative crystalloid administration decreased from 6.4 ml kg^-1 h^-1 (2015) to 5.5 ml kg^-1 h^-1 (2019).

Outlook:

• Supports the generalizability of the RELIEF trial findings.
• Emphasizes the challenge in translating evidence-based practices into routine clinical care.
• Underscores the need for continued research into optimal perioperative fluid management strategies.