Key result
Intraoperative goal-directed fluid therapy combined with an ERAS program did not significantly reduce the incidence of postoperative acute kidney injury compared to restrictive fluid therapy (4.3% vs 8.0%, p=0.317).
Why the study?
To investigate the effect of intraoperative goal-directed fluid therapy combined with an enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection.
Does intraoperative goal-directed fluid therapy combined with an ERAS program reduce postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection?
RCT (n=276)
Double-blind
1:1 ratio using random numbers
No
Does intraoperative goal-directed fluid therapy combined with an ERAS program reduce postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection?
Absolute Event Rate: 4.3% vs 8%
p-value: p=0.317
Goal-directed fluid therapy combined with ERAS does not significantly reduce overall postoperative complications compared to restrictive fluid therapy in elderly patients undergoing thoracoscopic pulmonary resection, though it may offer slight renal protection.
Background: To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods: Patients, more than 60-year-old, undergoing thoracoscopic pulmonary resection for non small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI) and mean arterial pressure (MAP), maintained the SVV<13%, CI>2.5L/min/m2, and MAP>65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP>65 mmHg. The incidence of postoperative acute kidney injury (AKI), pulmonary and cardiac complications were compared. Results: 276 patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were larger, the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P=0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9±25.2 μmol/L vs 97.1±17.6 μmol/L; P=0.048). Conclusions: Compared to ERAS program with RFT, ERAS program with GDFT has slight beneficial effect on postoperative renal function in elderly patients undergoing thoracoscopic pulmonary resection. Trial registration: Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.
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Ma et al. (2022) conducted an RCT in Non-small cell lung cancer (n=276). Goal-directed fluid therapy (GDFT) vs. Restrictive fluid therapy (RFT) was evaluated on Incidence of acute kidney injury (AKI) 48 hours after operation (p=0.317). Intraoperative goal-directed fluid therapy combined with an ERAS program did not significantly reduce the incidence of postoperative acute kidney injury compared to restrictive fluid therapy (4.3% vs 8.0%, p=0.317).
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