Fluid management during video-assisted thoracoscopic surgery for lung resection: A randomized, controlled trial of effects on urinary output and postoperative renal function

Idit Matot, Elia Dery, Yuri Bulgov, Barak Cohen, Joseph Paz, Nachum Nesher

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Increased perioperative fluid administration is an independent risk factor for lung injury after pulmonary resection. In clinical practice, fluid therapy is heavily guided by urinary output; however, diuretic response to plasma volume expansion has been reported to be blunted during anesthesia and surgery. We therefore hypothesized that in patients undergoing video-assisted thoracoscopic surgery, different regimens of intraoperative fluid management would not affect urinary output as would be expected in the nonsurgical scenario. Moreover, a restrictive perioperative fluid approach, as indicated in these operations, will not harm renal function. Methods: One hundred two patients undergoing video-assisted thoracoscopic surgery were randomly allocated to receive intraoperatively either high (8 mL/[kg·h]; n = 51) or low (2 mL/[kg·h]; n = 51) amounts of Ringer's lactate solution. The primary end point was intraoperative urinary output. Secondary end points included postoperative creatinine serum levels and postoperative complication rate. Results: Demographic and surgical data were comparable between groups. Regardless of the intraoperatively fluids administered (mean ± SD, 2131 ± 850 vs 1035 ± 652 mL in high and low groups, respectively; P <.0001), urinary output was similar (median 300 mL). Perioperative creatinine serum levels decreased significantly postoperatively and were not significantly different among the groups. Conclusions: In patients undergoing video-assisted thoracoscopic surgery, intraoperative urinary output and postoperative renal function are not affected by administration of fluids in the range of 2 to 8 mL/(kg·h). The clinical practice of administering fluids to enhance diuresis in the perioperative period should therefore be abandoned.

Original languageEnglish
Pages (from-to)461-466
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume146
Issue number2
DOIs
StatePublished - Aug 2013

Keywords

  • ASA
  • American Society of Anesthesiologists
  • POD
  • RL
  • Ringer's lactate solution
  • VATS
  • postoperative day
  • video-assisted thoracoscopic surgery

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