Restrictive versus liberal fluid therapy for major abdominal surgery.

Myles PS, Bellomo R, Corcoran T, et al.
N Engl J Med 2018;378:2263-2274.
NATA Rating :
Review by : C. von Heymann
NATA Review

This article has the potential to influence or even to change current clinical fluid therapy during surgery, as it questions the often advocated practice of restrictive fluid administration.

Although the study endpoints are different to previous studies in this field, the results suggest that a too restrictive infusion regimen during and the day after surgery is not associated with a lower rate of disability-free survival but with a higher rate of acute kidney injury.

Clinicians in the field of preoperative care should be aware that a fluid regimen aiming at a moderate increase of the patient’s weight (instead of a zero balance) may positively impact kidney function and surgical site infection after major abdominal surgery.

Christian von Heymann, MD, PhD, DEAA
Professor of Anaesthesiology and Intensive Care Medicine
Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy
Vivantes Klinikum im Friedrichshain
Berlin, Germany

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