Less Is More

Improved Outcomes in Surgical Patients with Conservative Fluid Administration and Central Venous Catheter Monitoring

Ronald M Stewart, Pauline K. Park, John P. Hunt, Robert C. McIntyre, Janet McCarthy, Lee Ann Zarzabal, Joel E Michalek

Research output: Contribution to journalArticle

89 Citations (Scopus)

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 2 × 2 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.

Original languageEnglish (US)
Pages (from-to)725-735
Number of pages11
JournalJournal of the American College of Surgeons
Volume208
Issue number5
DOIs
StatePublished - May 2009

Fingerprint

Central Venous Catheters
Catheters
Mechanical Ventilators
Pulmonary Artery
Acute Lung Injury
Dialysis
APACHE
Adult Respiratory Distress Syndrome
Physiologic Monitoring
Random Allocation
Renal Insufficiency
Therapeutics
Clinical Trials

ASJC Scopus subject areas

  • Surgery

Cite this

Less Is More : Improved Outcomes in Surgical Patients with Conservative Fluid Administration and Central Venous Catheter Monitoring. / Stewart, Ronald M; Park, Pauline K.; Hunt, John P.; McIntyre, Robert C.; McCarthy, Janet; Zarzabal, Lee Ann; Michalek, Joel E.

In: Journal of the American College of Surgeons, Vol. 208, No. 5, 05.2009, p. 725-735.

Research output: Contribution to journalArticle

Stewart, Ronald M ; Park, Pauline K. ; Hunt, John P. ; McIntyre, Robert C. ; McCarthy, Janet ; Zarzabal, Lee Ann ; Michalek, Joel E. / Less Is More : Improved Outcomes in Surgical Patients with Conservative Fluid Administration and Central Venous Catheter Monitoring. In: Journal of the American College of Surgeons. 2009 ; Vol. 208, No. 5. pp. 725-735.
@article{f1ae831c229b40bc9cca08478793b650,
title = "Less Is More: Improved Outcomes in Surgical Patients with Conservative Fluid Administration and Central Venous Catheter Monitoring",
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 2 × 2 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.",
author = "Stewart, {Ronald M} and Park, {Pauline K.} and Hunt, {John P.} and McIntyre, {Robert C.} and Janet McCarthy and Zarzabal, {Lee Ann} and Michalek, {Joel E}",
year = "2009",
month = "5",
doi = "10.1016/j.jamcollsurg.2009.01.026",
language = "English (US)",
volume = "208",
pages = "725--735",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Less Is More

T2 - 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.

AU - McCarthy, Janet

AU - Zarzabal, Lee Ann

AU - Michalek, Joel E

PY - 2009/5

Y1 - 2009/5

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 2 × 2 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.

AB - 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 2 × 2 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.

UR - http://www.scopus.com/inward/record.url?scp=64949201153&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64949201153&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2009.01.026

DO - 10.1016/j.jamcollsurg.2009.01.026

M3 - Article

VL - 208

SP - 725

EP - 735

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -