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Restrictive versus Decision Support Guided Fluid Therapy during Major Hepatic Resection Surgery: A Randomized

Sean Coeckelenbergh1, Maxim Soucy-Proulx2, Philippe Van der Linden3

  • 1Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France; and Outcomes Research Consortium, Cleveland, Ohio; Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California.

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Summary

Fluid management using decision support software during liver surgery significantly lowered arterial lactate levels. This approach offers a promising alternative to restrictive fluid strategies in major hepatic resections.

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Area of Science:

  • Hepatobiliary Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Minimizing fluid therapy during major hepatic resection aims to reduce complications like bleeding.
  • However, restrictive fluid strategies may increase arterial lactate levels (hyperlactatemia).
  • A novel Acumen assisted fluid management system offers algorithmic decision support for optimizing fluid therapy.

Purpose of the Study:

  • To test if a decision support system reduces arterial lactate levels post-hepatic resection.
  • To compare this system against a restrictive fluid strategy.

Main Methods:

  • A two-arm, randomized controlled trial involving 90 patients undergoing major liver surgery.
  • Fluid therapy was guided by the assisted fluid management software in one group.
  • The other group received a restrictive fluid strategy (1-2 ml·kg⁻¹·h⁻¹) until hepatectomy completion.

Main Results:

  • The decision support group showed significantly lower arterial lactate levels (2.5 mmol·l⁻¹) compared to the restrictive group (4.6 mmol·l⁻¹).
  • No significant difference in blood loss was observed between groups.
  • Central venous pressure was higher in the decision support group.

Conclusions:

  • Clinical decision support systems for fluid administration can lower arterial lactate in major hepatic resection.
  • Further research is needed to confirm these findings and guide clinical practice changes.