Goal directed fluid therapy reduces major

Abstract

Background: Optimal fluid management is crucial for patients undergoing surgical repair of abdominal aortic aneurysm (AAA). Persistent hypovolemia is associated with complications but fluid overload is also harmful. Aim: This study evaluates that perioperative fluid restriction would reduce complications and improve outcome through goal-directed strategies in patients undergoing AAA. Methods: Fifty patients, aged from 60 to 75 years undergoing elective surgical repair of AAA were included in this randomized study. Patients were divided into two groups, 25 for each: liberal group (L) receives 12 ml/kg/h and restrictive group (R) receives 4 ml/kg/h. Goal-directed-therapy approach was concerning assessment of tissue oxygenation. Dobutamine and fluid challenges were used to maintain adequate tissue perfusion during surgery. Results: The patients of the (L) group received a significant greater amount of Lactated Ringer’s solution (3586.76 ± 473.21) than the (R) group (1219 ± 140.6). The (R) group had 50% lower rate of major postoperative complications than the (L) group (24% vs 48%) and less hospital stay. Conclusion: A restrictive strategy of fluid maintenance during optimization of oxygen delivery with early treatment directed to maintain oxygen extraction ratio estimate (O2ERe) at <27% reduces major complications and hospital stay of surgical patients undergo abdominal aortic aneurysm.

Keywords

• Liberal
• Restrictive
• Goal-directed strategies
• O2ERe
• Abdominal aortic aneurysm