Liberal propaganda.

Brace yourself for it. Perioperative fluid restriction is a fairly new tactic thought to lessen tissue edema and complications, as reflected in current ERAS guidelines. Well, the Aussies weren’t so sure so they designed the phase 3 RELIEF trial that randomized almost 3K patients to receive restrictive versus liberal fluids surrounding a major abdominal surgery. “Major” was defined as an expected operative duration >2 hours and an expected hospital stay ≥3 days. The liberal group received fluids of 10 mL/kg bolus with anesthesia → 8 mL/kg during surgery → 1.5 mL/kg over the 24-hour postop period, while the restrictive group received approximately half that volume. The primary outcome of rate of disability-free survival at one year was no different between groups (82%). What were significantly higher with fluid restriction? Rates of acute kidney injury (AKI, 5 → 9%), renal replacement therapy (0.3 → 0.9%), and surgical site infection (14 → 17%). TBL: Stay liberal, surg onc. | Myles, N Engl J Med 2018