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

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.