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Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring.
J Am Coll Surg. 2009 May; 208(5):725-35; discussion 735-7.JA

Abstract

BACKGROUND

The ARDS Clinical Trials Network Fluid and Catheter Treatment Trial (FACTT) addressed fluid management and central monitoring of patients with acute respiratory distress syndrome/acute lung injury (ARDS/ALI). Because surgical patients may have been fundamentally different from the overall FACTT cohort, we set out to separately analyze the surgery patients in the trial.

STUDY DESIGN

We performed a posthoc, surgical subgroup analysis of 1,000 patients enrolled in the FACTT. Patients were randomized using a 2x2 factorial design comparing a conservative (CON) versus a liberal (LIB) strategy of fluid management and the use of a pulmonary artery catheter (PAC) or a central venous catheter (CVC). The primary end point was death at 60 days. Secondary end points included the number of ventilator-free days, ICU-free days, and dialysis-free days until hospital discharge up to day 90. We defined surgical patients as those admitted to a surgical ICU, burn ICU, or cardiac surgical ICU; trauma patients; or those with an APACHE III surgical admission type.

RESULTS

There were 244 surgical patients. Risk of death within 60 days of randomization did not vary with catheter or fluid management, and a corresponding lack of effect was evident with regard to dialysis-free days. Ventilator-free days were increased in the fluid-conservative group (LIB, 13+/-1 days; CON, 15+/-1 days; p=0.04) at 28 days. CVC patients had more ventilator-free days at 28 and 90 days (28 days: CVC, 16+/-1 days; PAC, 13+/-1 days; p=0.03; 90 days: CVC, 64+/-3 days; PAC, 57+/-4 days; p=0.03). CVC patients had more ICU-free days at 90 days (90 days: CVC, 63+/-3 days; PAC, 55+/-3 days; p=0.04).

CONCLUSIONS

The risk of death did not vary with fluid management or catheter. A conservative fluid-administration strategy and central venous catheter monitoring resulted in more ventilator-free and ICU-free days in surgical patients with acute lung injury, and conservative fluid administration did not result in more renal failure.

Authors+Show Affiliations

Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19476825

Citation

Stewart, Ronald M., et al. "Less Is More: Improved Outcomes in Surgical Patients With Conservative Fluid Administration and Central Venous Catheter Monitoring." Journal of the American College of Surgeons, vol. 208, no. 5, 2009, pp. 725-35; discussion 735-7.
Stewart RM, Park PK, Hunt JP, et al. Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. J Am Coll Surg. 2009;208(5):725-35; discussion 735-7.
Stewart, R. M., Park, P. K., Hunt, J. P., McIntyre, R. C., McCarthy, J., Zarzabal, L. A., & Michalek, J. E. (2009). Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. Journal of the American College of Surgeons, 208(5), 725-35; discussion 735-7. https://doi.org/10.1016/j.jamcollsurg.2009.01.026
Stewart RM, et al. Less Is More: Improved Outcomes in Surgical Patients With Conservative Fluid Administration and Central Venous Catheter Monitoring. J Am Coll Surg. 2009;208(5):725-35; discussion 735-7. PubMed PMID: 19476825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. AU - Stewart,Ronald M, AU - Park,Pauline K, AU - Hunt,John P, AU - McIntyre,Robert C,Jr AU - McCarthy,Janet, AU - Zarzabal,Lee Ann, AU - Michalek,Joel E, AU - ,, Y1 - 2009/03/31/ PY - 2008/12/03/received PY - 2009/01/16/revised PY - 2009/01/20/accepted PY - 2009/5/30/entrez PY - 2009/5/30/pubmed PY - 2009/6/19/medline SP - 725-35; discussion 735-7 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 208 IS - 5 N2 - BACKGROUND: The ARDS Clinical Trials Network Fluid and Catheter Treatment Trial (FACTT) addressed fluid management and central monitoring of patients with acute respiratory distress syndrome/acute lung injury (ARDS/ALI). Because surgical patients may have been fundamentally different from the overall FACTT cohort, we set out to separately analyze the surgery patients in the trial. STUDY DESIGN: We performed a posthoc, surgical subgroup analysis of 1,000 patients enrolled in the FACTT. Patients were randomized using a 2x2 factorial design comparing a conservative (CON) versus a liberal (LIB) strategy of fluid management and the use of a pulmonary artery catheter (PAC) or a central venous catheter (CVC). The primary end point was death at 60 days. Secondary end points included the number of ventilator-free days, ICU-free days, and dialysis-free days until hospital discharge up to day 90. We defined surgical patients as those admitted to a surgical ICU, burn ICU, or cardiac surgical ICU; trauma patients; or those with an APACHE III surgical admission type. RESULTS: There were 244 surgical patients. Risk of death within 60 days of randomization did not vary with catheter or fluid management, and a corresponding lack of effect was evident with regard to dialysis-free days. Ventilator-free days were increased in the fluid-conservative group (LIB, 13+/-1 days; CON, 15+/-1 days; p=0.04) at 28 days. CVC patients had more ventilator-free days at 28 and 90 days (28 days: CVC, 16+/-1 days; PAC, 13+/-1 days; p=0.03; 90 days: CVC, 64+/-3 days; PAC, 57+/-4 days; p=0.03). CVC patients had more ICU-free days at 90 days (90 days: CVC, 63+/-3 days; PAC, 55+/-3 days; p=0.04). CONCLUSIONS: The risk of death did not vary with fluid management or catheter. A conservative fluid-administration strategy and central venous catheter monitoring resulted in more ventilator-free and ICU-free days in surgical patients with acute lung injury, and conservative fluid administration did not result in more renal failure. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/19476825/Less_is_more:_improved_outcomes_in_surgical_patients_with_conservative_fluid_administration_and_central_venous_catheter_monitoring_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(09)00049-0 DB - PRIME DP - Unbound Medicine ER -