Trial reportAnesthesiology2024
Restrictive versus Decision Support Guided Fluid Therapy during Major Hepatic Resection Surgery: A Randomized Controlled Trial.
Trial report in Anesthesiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07301307 (The Use of the Hypotension Prediction Index), which is not on this map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Use of the Hypotension Prediction Index (HPI) Combined With the Assisted Fluid Management (AFM) Software for Perioperative Hemodynamic Optimization in Patients Undergoing General Anesthesia.
Who cites it
12 citing papers in PubMed.
- Effect of Two-Stage Goal-Directed Crystalloid versus Colloid Fluid Therapy on Postoperative Quality of Recovery in Patients Undergoing Laparoscopic Hepatectomy: A Randomized Controlled Trial.Drug design, development and therapy · 2025Trial
- Review
- Perioperative Patient Blood Management: Evidence-Based Strategies for Surgeons and Anesthesiologists: A Narrative Review.Journal of clinical medicine · 2026Review
- Hypovolemic phlebotomy and low central venous pressure: a paradigm shift in liver surgery?Hepatobiliary surgery and nutrition · 2026Article
- Implementation and learning curve in AI-assisted fluid management during abdominal oncologic surgery: a retrospective observational study.Journal of anesthesia, analgesia and critical care · 2026Article
- Anesthesia for cesarean delivery in the era of artificial intelligence: a narrative review.Journal of anesthesia, analgesia and critical care · 2026Review
- Fluid therapy in adults having non-cardiac surgery: A narrative review.Annals of intensive care · 2026Review
- Identification of intraoperative hypotension endotypes and revolution with a temporal deep learning algorithm.Perioperative medicine (London, England) · 2025Article
- Practice advisory on the management of the perioperative period of scoliosis correction surgery.Journal of anesthesia and translational medicine · 2025Review
- Emerging Technology and the Future of Perioperative Care: Perspectives and Recommendations From the 2023 Stoelting Conference of the Anesthesia Patient Safety Foundation.Anesthesia and analgesia · 2025Review
- Impact of Perioperative Fluid Strategies on Outcomes in Radical Cystectomy: A Systematic Review.Cancers · 2025Review
- Bilateral thoracic paravertebral block for robotic hepatectomy without hepatic portal occlusion for a cirrhosis patient: a case report.Frontiers in oncology · 2025Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundFluid therapy during major hepatic resection aims at minimizing fluids during the dissection phase to reduce central venous pressure, retrograde liver blood flow, and venous bleeding. This strategy, however, may lead to hyperlactatemia. The Acumen assisted fluid management system uses novel decision support software, the algorithm of which helps clinicians optimize fluid therapy. The study tested the hypothesis that using this decision support system could decrease arterial lactate at the end of major hepatic resection when compared to a more restrictive fluid strategy.
methodsThis two-arm, prospective, randomized controlled, assessor- and patient-blinded superiority study included consecutive patients undergoing major liver surgery equipped with an arterial catheter linked to an uncalibrated stroke volume monitor. In the decision support group, fluid therapy was guided throughout the entire procedure using the assisted fluid management software. In the restrictive fluid group, clinicians were recommended to restrict fluid infusion to 1 to 2 ml · kg-1 · h-1 until the completion of hepatectomy. They then administered fluids based on advanced hemodynamic variables. Noradrenaline was titrated in all patients to maintain a mean arterial pressure greater than 65 mmHg. The primary outcome was arterial lactate level upon completion of surgery (i.e., skin closure).
resultsA total of 90 patients were enrolled over a 7-month period. The primary outcome was lower in the decision support group than in the restrictive group (median [quartile 1 to quartile 3], 2.5 [1.9 to 3.7] mmol · l-1vs. 4.6 [3.1 to 5.4] mmol · l-1; median difference, -2.1; 95% CI, -2.7 to -1.2; P < 0.001). Among secondary exploratory outcomes, there was no difference in blood loss (median [quartile 1 to quartile 3], 450 [300 to 600] ml vs. 500 [300 to 800] ml; P = 0.727), although central venous pressure was higher in the decision support group (mean ± SD of 7.7 ± 2.0 mmHg vs. 6.6 ± 1.1 mmHg; P < 0.002).
conclusionsPatients managed using a clinical decision support system to guide fluid administration during major hepatic resection had a lower arterial lactate concentration at the end of surgery when compared to a more restrictive fluid strategy. Future trials are necessary to make conclusive recommendations that will change clinical practice. EDITOR’S PERSPECTIVE:
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