Goal-directed fluid therapy vs. low central venous pressure during major open liver resections (GALILEO): a surgeon- and patient-blinded randomized controlled trial.

Abstract

BACKGROUND\nLow central venous pressure (low-CVP) is the clinical standard for fluid therapy during major liver surgery. Although goal-directed fluid therapy (GDFT) has been associated with reduced morbidity and mortality in major abdominal surgery, concerns remain on blood loss when applying GDFT in liver surgery. This randomized trial compared outcomes of low-CVP and GDFT during major liver resections.\n\n\nMETHODS\nIn this surgeon- and patient-blinded RCT, patients undergoing major open liver resections (≥3 segments) were randomized between low-CVP (n\xa0=\xa020) or GDFT (n\xa0=\xa020). Primary outcome was intraoperative blood loss. Secondary outcomes included the quality of the surgical field (VAS scale 0 (worst)-100 (best)) and major morbidity (≥grade 3 Clavien-Dindo).\n\n\nRESULTS\nDuring surgery, CVP was 3\xa0±\xa02\xa0mmHg in the low-CVP group vs. 7\xa0±\xa03\xa0mmHg in the GDFT group (P\xa0<\xa00.001). Blood loss (1425 vs. 1275\xa0mL; P\xa0=\xa00.640) and the rate of major morbidity (40% vs. 50%, P\xa0=\xa00.751), did not differ between low-CVP and GDFT, respectively. The quality of the surgical field was comparable between groups (low-CVP 83% vs. GDFT 80%, P\xa0=\xa00.955).\n\n\nCONCLUSION\nIn major open liver resections, GDFT was not associated with differences in intraoperative blood loss, major morbidity or quality of the surgical field, compared to low-CVP. Larger RCTs are needed to confirm this finding. Registration number: NTR5821 (www.trialregister.nl).