A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery - the FOCCUS study

被引：10

作者：

Cuthbertson, Brian H. ^{[1
,2
]}

Campbell, Marion K. ^{[2
]}

Stott, Stephen A. ^{[3
]}

Elders, Andrew ^{[2
]}

Hernandez, Rodolfo ^{[2
,4
]}

Boyers, Dwayne ^{[4
]}

Norrie, John ^{[2
]}

Kinsella, John ^{[5
]}

Brittenden, Julie ^{[6
]}

Cook, Jonathan ^{[2
]}

Rae, Daniela ^{[2
]}

Cotton, Seonaidh C. ^{[2
]}

Alcorn, David ^{[7
]}

Addison, Jennifer ^{[2
]}

Grant, Adrian ^{[8
]}

机构：

[1] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada

[2] Univ Aberdeen, Hlth Serv Res Unit, Aberdeen AB25 2ZD, Scotland

[3] Aberdeen Royal Infirm, Intens Care Unit, Aberdeen AB25 2ZN, Scotland

[4] Univ Aberdeen, Hlth Econ Res Unit, Aberdeen AB25 2ZD, Scotland

[5] Univ Glasgow, Glasgow Royal Infirm, Sect Anaesthesia Pain & Crit Care, Glasgow G31 2HT, Lanark, Scotland

[6] Univ Aberdeen, Dept Surg, Aberdeen AB25 2ZD, Scotland

[7] Royal Alexandra Hosp, Paisley PA2 9PN, Strathclyde, Scotland

[8] Univ Aberdeen, Kings Coll, Inst Appl Hlth Sci, Aberdeen AB24 3FX, Scotland

来源：

CRITICAL CARE | 2011年 / 15卷 / 06期

关键词：

surgery; peri-operative management; fluid therapy; outcome; morbidity; optimisation; HOSPITAL STAY; PREOPERATIVE OPTIMIZATION; CLINICAL-TRIAL; MANAGEMENT; THERAPY; COMPLICATIONS; MORTALITY; METAANALYSIS; DOPEXAMINE;

D O I：

10.1186/cc10592

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. Methods: This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. Results: A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: 2,047; pound adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Conclusions: Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Trial registration: Prospective Clinical Trials, ISRCTN32188676

引用

页数：12

共 33 条

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