• Jannie Bisgaard, Rasmus Madsen, Lene L Dybdal, Jørgen T Lauridsen, Michael B Mortensen, and Anders G Jensen.
• From the Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg (JB), Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital (RM, LLD, AGJ), Open Patient Data Explorative Network (OPEN), Region of Southern Denmark (RM), The Centre of Health Economics Research (COHERE), University of Southern Denmark (JTL) and Department of Gastrointestinal Surgery A, Odense University Hospital, Odense, Denmark (MBM).
• Eur J Anaesthesiol. 2020 Jun 1; 37 (6): 491-502.

BackgroundGoal-directed therapy (GDT) is increasingly used in abdominal surgery. Whether crystalloids can exert the same effect as colloid, and how this may affect perfusion, is still unclear. The effect of GDT on the systemic oxygen delivery index (sDO2I) and the mesenteric oxygen delivery index (mDO2I) can be quantified by measuring cardiac index and flow in the superior mesenteric artery, respectively.ObjectiveThe aim of this study was to test the hypothesis that intra-operative GDT with bolus human albumin 5% is superior to GDT with bolus ringer acetate in maintaining sDO2I and mDO2I in elective major upper gastrointestinal cancer surgery.DesignRandomised controlled double blinded trial.SettingOdense University Hospital, Denmark, from May 2014 to June 2015.PatientsA total of 89 adults scheduled for elective major upper gastrointestinal cancer surgery were randomised and data from 60 were analysed.Exclusion Criteriacontraindications for using the LiDCOplus system, known allergy to albumin, pre-operative renal failure, pancreatic cancer and pre-operative down staging using chemotherapy and/or radiation therapy, pregnancy.InterventionsPatients were randomised to intra-operative GDT with either bolus human albumin or ringer acetate 250 ml, guided by pulse pressure variation and stroke volume.Main Outcome MeasuresChanges in sDO2I and mDO2I. Secondary outcomes were changes in other haemodynamic variables, fluid balance, blood transfusions, fluid-related complications and length of stay (LOS) in ICU and hospital.ResultsMedian [IQR] sDO2I was 522 [420 to 665] ml min m in the ringer acetate group and 490 [363 to 676] ml min m in the human albumin group, P = 0.36. Median [IQR] mDO2I was 12.1 [5.8 to 28.7] ml min m in the ringer acetate group and 17.0 [7.6 to 27.5] ml min m in the human albumin group, P = 0.17. Other haemodynamic comparisons did not differ significantly. More trial fluid was administered in the ringer acetate group. We found no significant difference in transfusions, complications or LOS.ConclusionBolus human albumin 5% was not superior to bolus ringer acetate in maintaining systemic or mesenteric oxygen delivery in elective major upper gastrointestinal cancer surgery, despite the administration of larger volumes of trial fluid in the ringer acetate group. No significant difference was seen in fluid-related complications or LOS.Trial Registrationhttps://eudract.ema.europa.eu/ Identifier: 2013-002217-36.

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