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dc.contributor.authorMyles, PSen_US
dc.contributor.authorBellomo, Ren_US
dc.contributor.authorCorcoran, Ten_US
dc.contributor.authorForbes, Aen_US
dc.contributor.authorPeyton, Pen_US
dc.contributor.authorStory, Den_US
dc.contributor.authorChristophi, Cen_US
dc.contributor.authorLeslie, Ken_US
dc.contributor.authorMcGuinness, Sen_US
dc.contributor.authorParke, Ren_US
dc.contributor.authorSerpell, Jen_US
dc.contributor.authorChan, MTVen_US
dc.contributor.authorPainter, Ten_US
dc.contributor.authorMcCluskey, Sen_US
dc.contributor.authorMinto, Gen_US
dc.contributor.authorWallace, Sen_US
dc.contributor.authorANZCA Clinical Trials Networken_US
dc.contributor.authorNZ Intensive Care Society Clinical Trials Groupen_US
dc.identifier.citation2018; doi:10.1056/NEJMoa1801601en_US
dc.description.abstractBACKGROUND Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion. METHODS In a pragmatic, international trial, we randomly assigned 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery. The primary outcome was disability-free survival at 1 year. Key secondary outcomes were acute kidney injury at 30 days, renal-replacement therapy at 90 days, and a composite of septic complications, surgical-site infection, or death. RESULTS During and up to 24 hours after surgery, 1490 patients in the restrictive fluid group had a median intravenous-fluid intake of 3.7 liters (interquartile range, 2.9 to 4.9), as compared with 6.1 liters (interquartile range, 5.0 to 7.4) in 1493 patients in the liberal fluid group (P<0.001). The rate of disability-free survival at 1 year was 81.9% in the restrictive fluid group and 82.3% in the liberal fluid group (hazard ratio for death or disability, 1.05; 95% confidence interval, 0.88 to 1.24; P=0.61). The rate of acute kidney injury was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P<0.001). The rate of septic complications or death was 21.8% in the restrictive fluid group and 19.8% in the liberal fluid group (P=0.19); rates of surgical-site infection (16.5% vs. 13.6%, P=0.02) and renal-replacement therapy (0.9% vs. 0.3%, P=0.048) were higher in the restrictive fluid group, but the between-group difference was not significant after adjustment for multiple testing. CONCLUSIONS Among patients at increased risk for complications during major abdominal surgery, a restrictive fluid regimen was not associated with a higher rate of disability-free survival than a liberal fluid regimen and was associated with a higher rate of acute kidney injury. (Funded by the Australian National Health and Medical Research Council and others; RELIEF number, NCT01424150.)en_US
dc.subjectmajor surgeryen_US
dc.subjectrestrictive fluid regimenen_US
dc.titleRestrictive versus liberal fluid therapy for major abdominal surgeryen_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleThe New England Journal of Medicineen_US
dc.description.affiliatesAustralian and New Zealand College of Anaesthetistsen_US
dc.description.affiliatesAlfred Hospitalen_US
dc.description.affiliatesMonash Universityen_US
dc.description.affiliatesUniversity of Melbourneen_US
dc.description.affiliatesAustin Hospital, Heidelbergen_US
dc.description.affiliatesRoyal Perth Hospitalen_US
dc.description.affiliatesUniversity of Western Australia, Perthen_US
dc.description.affiliatesRoyal Melbourne Hospitalen_US
dc.description.affiliatesRoyal Adelaide Hospitalen_US
dc.description.affiliatesDiscipline of Acute Care Medicine, University of Adelaideen_US
dc.description.affiliatesAuckland City Hospitalen_US
dc.description.affiliatesMedical Research Institute of New Zealanden_US
dc.description.affiliatesChinese University of Hong Kongen_US
dc.description.affiliatesUniversity Health Network, Torontoen_US
dc.description.affiliatesDerriford Hospital, Plymouth, United Kingdomen_US
dc.type.studyortrialRandom Allocationen_US
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
Appears in Collections:Scholarly and Clinical
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