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We concluded that a more restrictive fluid resuscitation strategy might shorten the period of mechanical ventilation in major burn patients.
All three recent replication studies of early goal-directed therapy retrieved lower requirements in RBC transfusion along with a more restrictive fluid filling policy [6 8].
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.
This trial provided evidence that more restrictive fluid management in critically ill patients results in improved lung function and shortened duration of mechanical ventilation and intensive care stay [19].
Three studies involving GDT and more restrictive fluid management were identified (Table 1).
No clear association was found between postoperative AKI and more restrictive fluid balances.
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Given that avoidance of fluid overload may improve wider postoperative outcomes, and that GDT appears to protect against AKI when compared with conventional fluid management, the use of GDT strategies to facilitate more restrictive perioperative fluid therapy while avoiding covert hypovolaemia merits further examination in larger trials.
There is evidence that a more restrictive, protocol-based fluid management – best with goal-directed fluid administration – might lead to fewer complications, e.g. after abdominal surgery or elective colorectal resection, respectively [ 8- 10].
◆ The preemptive use of GDT with fluids and inotropes targeting DO2 and a more restrictive strategy of fluid maintenance during surgery leads to fewer major complications in high-risk patients undergoing major surgery.
Among the surgical studies not meeting the inclusion criteria, three recent studies examined a more restrictive perioperative maintenance fluid infusion combined with the use of GDT in one or both groups to facilitate a conservative maintenance fluid regimen [ 44- 46].
Lately, this traditional point of view has been progressively challenged, and a growing number of authors now propose a more restrictive approach to fluid management, although doubt remains as to the true hemodynamic influence of preoperative fasting.
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