Clinical review: Volume of fluid resuscitation and the incidence of acute kidney injury - a systematic review
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Why the study?
Does goal-directed therapy-based fluid resuscitation reduce postoperative acute kidney injury in adult patients undergoing major surgery?
Population
24 RCTs pooling 2,763 adult patients undergoing major surgery.
Comparison
Goal-directed therapy-based fluid resuscitation… vs Standard haemodynamic therapy (standard of care).
Design
Meta-analysis
Follow-up
postoperative
Authors
Discussion
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Implication
Supports GDT to reduce postoperative AKI in major surgery; extends RCT evidence via meta-analysis of fluid optimization strategies.
Structured PICO
Does goal-directed therapy-based fluid resuscitation reduce postoperative acute kidney injury in adult patients undergoing major surgery?
P
Population
24 RCTs pooling 2,763 adult patients undergoing major surgery.
I
Intervention
Goal-directed therapy (GDT)-based fluid resuscitation (FR) alone or in combination with inotropic drugs, targeting physiological measurements related to adequacy of cardiac output, systemic oxygen delivery, or ventricular preload, commencing before or within 8 hours from commencement of surgery.
C
Comparator
Standard haemodynamic therapy (standard of care).
O
Outcome
Postoperative acute kidney injury (AKI) defined by absolute or relative change in serum creatinine or urea, a defined period of oliguria, a need for renal replacement therapy, or a combination of these.hard clinical
Goal-directed therapy-based fluid resuscitation decreases postoperative acute kidney injury in surgical patients, particularly when supported by inotropic drugs and without requiring large increases in total fluid volume.
Cite This Study
Prowle et al. (2012) studied this question.
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