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LL: late liberal fluid management, defined as the absence of 2 consecutive negative daily fluid balances within first week of ICU stay.
This showed increased ventilator free days and trends towards reduced mortality with no change in other organ dysfunction with restrictive fluid balance compared to a liberal fluid balance.
However, hemodynamic targets have been poorly explored although avoidance of both hypovolemic status and too liberal fluid administration is the bottom line [1, 2].
Moreover, the study was performed in the late 1990s at the time when liberal fluid filling accounted for a high incidence of dilution anemia.
Traditionally, patients undergoing surgery have been managed with a liberal fluid strategy in which fluids are administered to fill the non-existent 'third space' [5] [7].
Group A were patients who admitted to the ICU where a more restrictive fluid management Method was conducted; Group B were patients who admitted to other ICUs where more liberal fluid management approach was applied.
Objectives The aim of this study is to assess if is better to reduce postoperative complications, optimizing hemodynamic situation after hepatic resection guided by dynamic variables preload (PPV and SVV) versus using liberal fluid management.
In a sequential cohort study Yunos and colleagues demonstrated that a chloride liberal fluid (NS) was associated with a much higher incidence of renal failure than critically patients resuscitated with a chloride restrictive fluid (LR and Plasmalyte) [32].
The policy of liberal fluid administration should be questioned.
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It has been demonstrated that ischemia and chloride-liberal fluid management cause AKI in liver transplantation [ 1].
Some animal studies suggest that administration of chloride-liberal fluid induces renal vasoconstriction and a decline in glomerular filtration rate [ 11, 12].
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