• Anne A Aaen, Anders W Voldby, Nicolas Storm, Jeppe Kildsig, Egon G Hansen, Erik Zimmermann-Nielsen, Kenneth M Jensen, Pernille Tibæk, Anette Mortensen, Ann M Møller, and Birgitte Brandstrup.
• Department of Anaesthesia, Holbæk Hospital, Part of Copenhagen University Hospitals, Holbaek, Denmark. Electronic address: aaaa@regionsjaelland.dk.
• Br J Anaesth. 2021 Oct 1; 127 (4): 521-531.

BackgroundMore than 50% of patients have a major complication after emergency gastrointestinal surgery. Intravenous (i.v.) fluid therapy is a life-saving part of treatment, but evidence to guide what i.v. fluid strategy results in the best outcome is lacking. We hypothesised that goal-directed fluid therapy during surgery (GDT group) reduces the risk of major complications or death in patients undergoing major emergency gastrointestinal surgery compared with standard i.v. fluid therapy (STD group).MethodsIn a randomised, assessor-blinded, two-arm, multicentre trial, we included 312 adult patients with gastrointestinal obstruction or perforation. Patients in the GDT group received i.v. fluid to near-maximal stroke volume. Patients in the STD group received i.v. fluid following best clinical practice. Postoperative target was 0-2 L fluid balance. The primary outcome was a composite of major complications or death within 90 days. Secondary outcomes were time in intensive care, time on ventilator, time in dialysis, hospital stay, and minor complications.ResultsIn a modified intention-to-treat analysis, we found no difference in the primary outcome between groups: 45 (30%) (GDT group) vs 39 (25%) (STD group) (odds ratio=1.24; 95% confidence interval, 0.75-2.05; P=0.40). Hospital stay was longer in the GDT group: median (inter-quartile range), 7 (4-12) vs 6 days (4-8.5) (P=0.04); no other differences were found.ConclusionCompared with pressure-guided i.v. fluid therapy (STD group), flow-guided fluid therapy to near-maximal stroke volume (GDT group) did not improve the outcome after surgery for bowel obstruction or gastrointestinal perforation but may have prolonged hospital stay.Clinical Trial RegistrationEudraCT number 2015-000563-14; the Danish Scientific Ethics Committee and the Danish Data Protection Agency (REG-18-2015).Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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