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

J Thorac Cardiovasc Surg. 2013 Aug;146(2):461-6. doi: 10.1016/j.jtcvs.2013.02.015. Epub 2013 Apr 1.

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.

Trial registration: ClinicalTrials.gov NCT00854386.

Keywords: 1; 10.4; 41.2; 41.3; ASA; American Society of Anesthesiologists; POD; RL; Ringer's lactate solution; VATS; postoperative day; video-assisted thoracoscopic surgery.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Biomarkers / blood
  • Chi-Square Distribution
  • Creatinine / blood
  • Female
  • Fluid Therapy / adverse effects
  • Fluid Therapy / methods*
  • Fluid Therapy / mortality
  • Humans
  • Intraoperative Care
  • Isotonic Solutions / administration & dosage*
  • Israel
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods*
  • Pneumonectomy / adverse effects
  • Pneumonectomy / methods*
  • Pneumonectomy / mortality
  • Ringer's Lactate
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Thoracic Surgery, Video-Assisted* / mortality
  • Treatment Outcome
  • Urination*
  • Water-Electrolyte Balance

Substances

  • Biomarkers
  • Isotonic Solutions
  • Ringer's Lactate
  • Creatinine

Associated data

  • ClinicalTrials.gov/NCT00854386