restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery限制战略术中液体维护期间优化氧交付减少高风险手术后主要并发症.pdfVIP

Lobo et al. Critical Care 2011, 15:R226 /content/15/5/R226 RESEARCH Open Access Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery 1* 2 1 3 3 2 Suzana M Lobo , Luis S Ronchi , Neymar E Oliveira , Paulo G Brandão , Adriano Froes , Geni S Cunrath , Kátia G Nishiyama1, João G Netinho2 and Francisco R Lobo3 Abstract Introduction: Optimal fluid management is crucial for patients who undergo major and prolonged surgery. Persistent hypovolemia is associated with complications, but fluid overload is also harmful. We evaluated the effects of a restrictive versus conventional strategy of crystalloid administration during goal-directed therapy in high-risk surgical patients. Methods: We conducted a prospective, randomized, controlled study of high-risk patients undergoing major surgery. For fluid maintenance during surgery, the restrictive group received 4 ml/kg/hour and the conventional group received 12 ml/kg/hour of Ringer’s lactate solution. A minimally invasive technique (the LiDCO monitoring system) was used to continuously monitor stroke volume and oxygen delivery index (DO2I) in both groups. Dobutamine was administered as necessary, and fluid challenges were used to test fluid responsiveness to achieve the best possible DO2I during surgery and for 8 hours postoperatively. Results: Eighty-eight patients were included. The patients’ median age was 69 years. The conventional treatment group received a significantly greater amount of lactated Ringer’s solution (mean ± standard deviation (SD): 4, 335 ± 1, 546 ml) than the restrictive group (mean ± SD: 2, 301 ± 1, 064 ml) (P 0.001). Temporal patt