Table 2.
Trials of “goal-directed fluid therapy” (GDT) in abdominal surgery versus “zero-balance fluid therapy” (restricted)
| Author | Surgery | No. of patients/ASA | Blinding/monitor/timing | Primary outcome | Intervention | Preoperative fluid volume, mL (restricted vs. GDT) | Intraoperative fluid volume, mL (restricted vs. GDT) | Postoperative fluid volume, mL (restricted vs. GDT) | Effect of GDT |
|---|---|---|---|---|---|---|---|---|---|
| Brandstrup et al. [62] | Elective laparoscopic or open colectomy | 150/ASA I-III | Observer blinded/ODM, CardioQ®/intraoperative | Postop. complications | Optimizing SV (<10 %) with HES 6 %, 130/0.4 (Voluven®) |
2 h fasting for fluid 500 mL saline if no fluid in 6 h |
Coll: 475 vs. 810 Cryst: 443 vs. 483 Totala: 1491 vs. 1876 |
Early oral intake in an enhanced recovery protocol. Iv-fluid if oliguria, tachycardia or hypotension |
→ Complications → LOS Mortality: 1 (restricted) vs. 1 (GDT) |
| Zhang et al. [64] | Elective open GI surgery | 60 in three groups: 4 mL/kg/h RL + GDT-HES, 4 mL/kg/h RL + GDT-RL, and 4 mL/kg/h RL alone/ASA I-II |
Observer blinded/Datex Ohmeda®/intraoperative | LOS | Optimizing PPV (<11 %) with Ringer’s lactate and HES 6 % | Not given | Total volume: GDT-HES: 1742 vs. GDT-RL: 2109 vs. RL alone: 1260 |
1.5–2.0 mL/kg/h crystalloid for 3 days Oral intake not mentioned. |
↓ LOS in GDT-HES ↓ Time to flatus in GDT-HES → Complications between groups Mortality: none |
| Srinivasa et al. [61] | Elective laparoscopic or open colectomy | 85/ASA I-III | Observer blinded/ODM, CardioQ®/intraoperative | Surgical recovery score (SRS) | Optimizing cFT (<350 ms) and SV (<10 %) with Gelofusine | 13 patients with bowel preparation: 1000 mL crystalloid | Coll: 297 vs. 591 Totala: 1614 vs. 1994 |
Early oral intake in an enhanced recovery protocol. IV fluid if oliguria, tachycardia, or hypotension |
→ SRS → LOS → Complications Mortality: none |
| Phan et al. [60] | Elective colorectal surgery | 100/ASA I-III | Observer blinded/ODM, CardioQ®/intraoperative | LOS | Optimizing cFT (<360 ms) and SV (<10 %) with any colloid | 400 mL PreOp® the day before and 2 h preop. | Coll: 0 vs. 500 Cryst: 1400 vs. 1500 Totala: 1500 vs. 2190 |
Early oral intake in an enhanced recovery protocol | → LOS → Complications Mortality: 1 (restricted) vs. 0 (GDT) |
LOS length of hospital stay, ODM Oesophageal Doppler Monitoring, SV Stroke Volume, PPV Pulse Pressure Variation, cFT corrected Flow Time
aTotal volume infused including colloid, crystalloid and blood products
↑significantly increased, ↓ significantly decreased, → no significant changes