Low Versus Standard Urine Output Targets in Patients Undergoing Major Abdominal Surgery: A Randomized Noninferiority Trial.
Ann Surg
; 265(5): 874-881, 2017 05.
Article
em En
| MEDLINE
| ID: mdl-27763895
ABSTRACT
OBJECTIVE:
To determine whether a low perioperative minimum urine output target is safe and fluid sparing when compared with the standard target.BACKGROUND:
A minimum hourly urine output of 0.5âmL/kg is a key target guiding perioperative fluid therapy. Few data support this standard practice, which may contribute to perioperative fluid overloading.METHODS:
We randomized patients without significant risk factors for acute kidney injury undergoing elective colectomy to a minimum urine output target of 0.2âmL/kg/h (low group) or 0.5âmL/kg/h (standard group) from induction of anesthesia until 8âAM 2 days after surgery. Maintenance fluids were standardized and additional fluids administered to achieve the targets. Primary outcome was noninferiority for urine neutrophil gelatinase-associated lipocalin on the day after surgery.RESULTS:
Between November 21, 2011 and July 11, 2013, 40 participants completed the study. The low group received 3170âmL (95% confidence interval 2380-3960) intravenous fluids versus 5490âmL (95% confidence interval 4570-6410) in the standard group (P = 0.0004), and was noninferior for neutrophil gelatinase-associated lipocalin [14.7âµg/L (interquartile range 7.60-28.9) vs 18.4âµg/L (interquartile range 8.30-21.2); Pnoninferiority = 0.0011], serum cystatin C (Pnoninferiority < 0.0001), serum creatinine (Pnoninferiority = 0.0004), and measured glomerular filtration (Pnoninferiority = 0.0003). Effective renal plasma flow increased in both groups after surgery, and more in the standard group (Pnoninferiority = 0.125).CONCLUSIONS:
A perioperative urine output target of 0.2âmL/kg/h is noninferior to the standard target of 0.5âmL/kg/h and results in a large intravenous fluid sparing. This target should be adopted in surgical patients without significant kidney injury risk factors.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Oligúria
/
Colectomia
/
Injúria Renal Aguda
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Oceania
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article