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Please use this identifier to cite or link to this item: https://hdl.handle.net/11055/566
Title: Restrictive versus liberal fluid therapy for major abdominal surgery
Authors: Myles, PS 
Bellomo, R
Corcoran, T
Forbes, A
Peyton, P
Story, D
Christophi, C
Leslie, K 
McGuinness, S 
Parke, R
Serpell, J
Chan, MTV 
Painter, T
McCluskey, S
Minto, G
Wallace, S
ANZCA Clinical Trials Network 
NZ Intensive Care Society Clinical Trials Group
Keywords: major surgery
perfusion
restrictive fluid regimen
RELIEF
Issue Date: 14-Jun-2018
Source: 2018; doi:10.1056/NEJMoa1801601
Abstract: BACKGROUND 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 ClinicalTrials.gov number, NCT01424150.)
URI: http://hdl.handle.net/11055/566
ISSN: 0028-4793
Appears in Collections:Scholarly and Clinical

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