Impact of Restrictive Fluid Therapy on the Survival and Clinical Outcomes of Patients with Lower Gastrointestinal Disease Requiring Open Abdomen Management

Abstract

In this study, we investigated the efficacy of restrictive fluid therapy as a fluid management strategy during open abdomen management (OAM) for lower gastrointestinal diseases. We retrospectively analyzed the data of 53 patients who underwent OAM during their initial surgery for sepsis associated with lower gastrointestinal diseases over the previous six-year period. Patients were divided into two groups: the goal-directed hemodynamic therapy (GDHT) group, in which fluid management was guided by pulse pressure variations, stroke volume variations, stroke volume index, and urine output; and the restrictive normovolemic therapy (RNT) group, in which fluid management was guided by the mean arterial pressure and lactate levels. The 28-day mortality rate (33.3％ vs. 28.1％) did not differ significantly between the two groups. However, the cumulative fluid balance was significantly lower in the RNT group. Furthermore, the duration of OAM, the period of mechanical ventilation, and the tracheostomy rate were all also significantly lower in the RNT group. Restrictive fluid therapy for lower gastrointestinal diseases requiring OAM might not significantly improve the survival, but it could contribute to shortening of the treatment duration without increasing complications.