The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study.

Silva JM, Jr., de Oliveira AM, Nogueira FA, et al.
Crit Care 2013;17:R288.
NATA Rating :
Review by : M. Piagnerelli
NATA Review

This study was conducted over one year and included 479 patients requiring ICU stay after scheduled major surgery. The authors concluded that higher fluid balance during surgery increased morbidity (longer ICU stay, higher incidence of infection, neurological, cardiovascular and respiratory complications) and mortality. Fluid balance was an independent factor for death in multivariate analysis.

Nevertheless, this study has many limitations: exclusion of diabetic patients (the most severe patients), no data about fluid loss during the surgery (difficult to assess) and especially no application of an algorithm of fluid responsiveness (with static and/or dynamic parameters) during major surgery. Indeed, the use of fluid was only estimated by heart rate, blood pressure and urine output. These patients were in fact not well resucitated, with a high levels of lactate at ICU admission.

This study really highlights the need for monitoring to assess the fluid responsiveness in these patients. Give insufficient or too much fluids, that’s the question!

– Michael Piagnerelli