Restricted Versus Liberal Versus Goal-Directed Fluid Therapy for Non-vascular Abdominal Surgery: A Network...

Area of Science:

• Anesthesiology and Perioperative Medicine
• Surgical Critical Care
• Evidence-Based Medicine

Background:

• Optimal perioperative fluid management is critical for surgical outcomes.
• Over- or under-fluid administration can lead to significant complications.
• Existing fluid therapy strategies (liberal, restrictive, goal-directed) lack a clear consensus on superiority.

Purpose of the Study:

• To compare the effectiveness of liberal fluid therapy (LFT), restrictive fluid therapy (RFT), and goal-directed fluid therapy (GDT) in adult surgical patients undergoing non-vascular abdominal surgery.
• To identify the optimal fluid management strategy for improving perioperative outcomes.

Main Methods:

• Systematic review and network meta-analysis (NMA) including node-splitting and meta-regression.
• Literature search across major databases (PubMed, Cochrane, EMBASE, Google Scholar, Web of Science).
• Inclusion of 102 randomized controlled trials (RCTs) involving 12,100 adult patients; exclusion of pediatric, obstetric, and cardiac surgery trials.

Main Results:

• GDT utilizing FloTrac was most effective for reducing length of stay (LOS) and wound complications.
• GDT utilizing pulse pressure variation excelled in reducing overall complication rates, renal, respiratory, and cardiac complications.
• LFT was most effective for reducing mortality, while GDT with esophageal Doppler reduced anastomotic leaks. Evidence quality was generally low to very low.

Conclusions:

• Goal-directed fluid therapy (GDT) demonstrates superior effectiveness in preventing various complications (excluding mortality) compared to standard, liberal, or restricted fluid therapy.
• Specific GDT monitoring tools (FloTrac, pulse pressure variation, esophageal Doppler) offer distinct advantages for different outcomes.
• Despite promising results for GDT, the overall low quality of evidence necessitates cautious interpretation and further high-quality research.