REVOLUTION
Trial question
What is the role of decision support-guided fluid therapy in patients undergoing major liver surgery?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
46.0% female
54.0% male
N = 90
90 patients (41 female, 49 male).
Inclusion criteria: adult patients undergoing major liver surgery.
Key exclusion criteria: age < 18 years; cardiac arrhythmias; linguistic barrier; pregnancy.
Interventions
N=45 decision support-guided fluid therapy (fluid therapy guided throughout the entire procedure using an assisted fluid management software).
N=45 restrictive fluid strategy (targeting to restrict fluid infusion to 1-2 mL/kg/hr until the end of surgery).
Primary outcome
Median arterial lactate level upon completion of surgery
2.5 mmol/L
4.6 mmol/L
4.6 mmol/L
3.4 mmol/L
2.3 mmol/L
1.1 mmol/L
0.0 mmol/L
Decision support-guided fluid
therapy
Restrictive fluid
strategy
Significant
decrease ▼
Significant decrease in median arterial lactate level upon completion of surgery (2.5 mmol/L vs. 4.6 mmol/L; MD -2.1, 95% CI -2.7 to -1.2).
Secondary outcomes
No significant difference in median blood loss (500 mL vs. 450 mL; MD 50, 95% CI -200 to 150).
Significant increase in mean central venous pressure (7.7 mmHg vs. 6.6 mmHg; MD 1.1, 95% CI 0.4 to 1.8).
No significant difference in AKI (17.8% vs. 26.7%; ARD -8.9, 95% CI -25.6 to 8.4).
Safety outcomes
No significant difference in postoperative complications at day 30.
Conclusion
In adult patients undergoing major liver surgery, decision support-guided fluid therapy was superior to restrictive fluid strategy with respect to median arterial lactate level upon completion of surgery.
Reference
Sean Coeckelenbergh, Maxim Soucy-Proulx, Philippe Van der Linden et al. Restrictive versus Decision Support Guided Fluid Therapy during Major Hepatic Resection Surgery: A Randomized Controlled Trial. Anesthesiology. 2024 Nov 1;141(5):881-890.
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