This is research conducted on surgical patients. 1. Can a - TopicsExpress

This is research conducted on surgical patients. 1. Can a restricted fluid protocol improve tissue healing? 2. Can a restricted fluid protocol prevent cardiopulmonary complications? Patients planned for colorectal resectionwere randomly allocated to either a restricted (R) or a standard (S) intra- and postoperative intravenous fluid regimen (86 in each group). The R regimen was designed to replacemeasured fluid losses but without a postoperative weight gain. During surgery, fluid preloading of the epidurals and fluids for the nonanatomical third space loss were omitted. Blood was replaced with hydroxyethyl starch (HES) 6% volume for volume (with allowance for a maximum of 500 mL extra). The same principles were followed postoperatively, and a body weight increase of more than 1 kg was treated with furosemide. The administered fluid volume on the day of surgery was a median of 2740 mL in the R group versus 5388 mL in the S group, and on the first postoperative day R versus S was 500 versus 1500 mL. Administered fluid on postoperative days 2–6 was similar. Complications were registered after 30 days of follow-up by both an unblinded (clinical) and a blinded assessment. Postoperative complications were significantly reduced by the restricted fluid therapy (R versus S, ITT-analysis: 28 (33%) versus 44 (51%), PZ0.013; per-protocol analysis: 21 (30%) versus 40 (56%), PZ0.003). The two hypotheseswere confirmed (R versus S: tissue healing complications 11 (16%) versus 22 (31%), PZ0.040; cardiopulmonary complications 5 (7%) versus 17 (24%), PZ0.007). A dose-response relation between administered fluid volume and postoperative complications was found (P!0.001). Four patients in the standard group died, but there were no deaths in the restricted group (absolute risk reduction 5.6, 95% CI: 0.3–10.9%). In all cases, the cause of death was a cardiopulmonary complication. Adverse effects were lower diuresis and higher creatinine (but not urea) on the day of surgery in the R group. On the other hand, patients in the S group had lower arterial pH, a lower concentration of bicarbonate, and negative base excess in the immediate postoperative period (P!0.01).126 Furthermore, the S regimen caused haemodilution, with lower concentrations of serum albumin and total protein. The restricted regimen did not cause haemodynamically unstable patients; no significant differences in intra- and postoperative arterial blood pressures were found, and the administration of pressor substances was similar. Best Practice & Research Clinical Anaesthesiology Vol. 20, No. 2, pp. 265–283, 2006