{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:27:24Z","timestamp":1785407244575,"version":"3.56.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2011,9,23]],"date-time":"2011-09-23T00:00:00Z","timestamp":1316736000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2011,9,23]],"date-time":"2011-09-23T00:00:00Z","timestamp":1316736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>Optimal fluid management is crucial for patients who undergo major and prolonged surgery. Persistent hypovolemia is associated with complications, but fluid overload is also harmful. We evaluated the effects of a restrictive versus conventional strategy of crystalloid administration during goal-directed therapy in high-risk surgical patients.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>We conducted a prospective, randomized, controlled study of high-risk patients undergoing major surgery. For fluid maintenance during surgery, the restrictive group received 4 ml\/kg\/hour and the conventional group received 12 ml\/kg\/hour of Ringer's lactate solution. A minimally invasive technique (the LiDCO monitoring system) was used to continuously monitor stroke volume and oxygen delivery index (DO<jats:sub>2<\/jats:sub>I) in both groups. Dobutamine was administered as necessary, and fluid challenges were used to test fluid responsiveness to achieve the best possible DO<jats:sub>2<\/jats:sub>I during surgery and for 8 hours postoperatively.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>Eighty-eight patients were included. The patients' median age was 69 years. The conventional treatment group received a significantly greater amount of lactated Ringer's solution (mean \u00b1 standard deviation (SD): 4, 335 \u00b1 1, 546 ml) than the restrictive group (mean \u00b1 SD: 2, 301 \u00b1 1, 064 ml) (<jats:italic>P<\/jats:italic> &lt; 0.001). Temporal patterns of DO<jats:sub>2<\/jats:sub>I were similar between the two groups. The restrictive group had a 52% lower rate of major postoperative complications than the conventional group (20.0% vs 41.9%, relative risk = 0.48, 95% confidence interval = 0.24 to 0.94; <jats:italic>P<\/jats:italic> = 0.046).<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>A restrictive strategy of fluid maintenance during optimization of oxygen delivery reduces major complications in older patients with coexistent pathologies who undergo major surgery.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Trial registration<\/jats:title>\n                        <jats:p>ISRCTN: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.controlled-trials.com\/ISRCTN94984995\">ISRCTN94984995<\/jats:ext-link><\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc10466","type":"journal-article","created":{"date-parts":[[2011,9,23]],"date-time":"2011-09-23T18:24:43Z","timestamp":1316802283000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":95,"title":["Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery"],"prefix":"10.1186","volume":"15","author":[{"given":"Suzana M","family":"Lobo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis S","family":"Ronchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neymar E","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo G","family":"Brand\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriano","family":"Froes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geni S","family":"Cunrath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e1tia G","family":"Nishiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o G","family":"Netinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco R","family":"Lobo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2011,9,23]]},"reference":[{"key":"9751_CR1","unstructured":"Cullinane M, Gray AJG, Hargraves CMK, Lansdown M, Martin IC, Schubert M: The 2003 report of the National Confidential Enquiry into Perioperative Deaths.[http:\/\/www.ncepod.org.uk\/pdf\/2003\/03full.pdf]"},{"key":"9751_CR2","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1093\/bja\/54.8.819","volume":"54","author":"FG Fowkes","year":"1982","unstructured":"Fowkes FG, Lunn JN, Farrow SC, Robertson IB, Samuel P: Epidemiology in anaesthesia. 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