Review Article

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Table 1

Main characteristics of the studies included in this review.

Author, yearsNAge, range (average)Sex (M/F)ASA (N)Fluid AFluid BFluid COperationPrimary outcome/primary end point

Ando et al. [18], 20082167 (60, 70)12/9I/II (9/12)Acetate RingerHES70/0.5 (Hespander)Major abdominal surgeryUrinary microalbumin/creatinine ratio
Chaudhary et al. [19], 20086041 ± 11.06I/IILRS 2 mL/kgLRS 12 mL/kg4.5% hetastarch 12 mL/kgOpen cholecystectomyPONV at 24 hours (VAS)
Demir et al. [20], 20183642.72 ± 13.2525/11II/III/IV (21/8/7)6% HES130/0.4 (Voluven)4% gelatin (Gelofusine)Living donor liver transplantRenal function (Cr, BUN, and GFR)
Deng et al. [21], 20173640–8020/16I/IILRS4% gelatin (Gelofusine)4.5% NaCl in 7.6% HES40Laparoscopic colonic surgeryMucosal blood flow (Pg-aCO2)
Feldheiser et al. [15], 20134852.5 (45.5, 59)I/II/III (4/24/20)Jonosteril6% HES130/0.4 (Volulyte)Cytoreductive surgeryAmount of fluid
Ghodraty et al. [22], 20179153.2 ± 12.360/31II/III (38/53)LRS6% HES130/0.4 (Voluven)GI surgeryPresence of bowel function
Hung et al. [23], 20148048 ± 10.748/32LRS6% HES130/0.4 (Voluven)Major abdominal surgeryThromboelastogram
Ickx et al. [24], 20034062 (47–72)39/1II/III6% HES130/0.4 (Voluven)6% HES200/0.5 (HAES-steril)Major abdominal surgeryPlasma substitution effect (CO, RVEDV)
Jin et al. [25], 20104249 ± 1015/27I/IILRS6% HES130/0.4 (Voluven)4% gelatin (Gelofusine)GastrectomyThromboelastogram
Joosten et al. [17], 201816062 (48–70)96/84II/III (93/67)Plasmalyte6% HES130/0.4 (Volulyte)Major abdominal surgeryPostoperative complication at day 2
Kammerer et al. [26], 201810070 (61–75)81/19I/II/III/IV (6/38/63/2)5% human albumin6% HES130/0.4 (Voluven)CystectomySerum cystatin C ratio (preoperative/ postoperative day 90)
Kancir et al. [27], 20153664 (4.8)NSS6% HES130/0.4 (Voluven)Radical cystectomyUrine NGAL
Khajavi et al. [28], 20085440 ± 14NSSLRSLiving donor kidney transplantSerum potassium and pH
Kim et al. [29], 20136046 ± 1238/22III/IVNSSPlasmalyteLiving donor kidney transplantRenal function
Lavu et al. [30], 201425968.3 (25–91)39%/46%III (167)LRS3% sodium chloridePancreaticoduodenectomyPostoperative complication
Liang et al. [31], 20103557 ± 815/20I/II6% HES130/0.4 (Voluven)6% HES200/0.5 (HAES-steril)Laparoscopy-assisted radical colectomyThromboelastogram
Loffel et al. [32], 20164471.5 (33–82)30/14II/III (28/16)Ringer maleateChloride-depleted glucose solution 5% (G5K)CystectomyFirst defecation
Mahmood et al. [33], 20076272 (7)50/126% HES 200/0.62 (Elohes)6% HES130/0.4 (Voluven)4% gelatin (Gelofusine)Open AAA repairSplanchnic perfusion (gastric pH)
Mahmood et al. [34], 20096272 (7)50/126% HES 200/0.62 (Elohes)6% HES130/0.4 (Voluven)4% gelatin (Gelofusine)Open AAA repairRenal function (Cr, GFR)
Marik et al. [35], 199730LRSHES670/0.75 (hetastarch)Open AAA repairMaximal change of gastric pH
Mishra et al. [36], 201710039.6 ± 11.5428/72I/II (81/19)NSS5% DextroseLaparoscopic cholecystectomyIncidence of PONV
Modi et al. [37], 20127218–62-NSSLRSLiving donor kidney transplantAcidosis, potassium
Mukhtar et al. [38], 20094051 ± 635/55% human albumin6% HES130/0.4 (Voluven)Living donor liver transplantCreatinine clearance at 24 hours
O’Malley et al. [39], 20055144 ± 1332/19NSSLRSKidney transplantCr at postoperative day 3
Potura et al. [40], 201514856 ± 1395/53NSSElomel-IsotonCadaveric kidney transplantPerioperative hyperkalemia
Ragaller et al. [41], 20002968.4 ± 8.526/3I/II/III6% HES200/0.5 + 0.9%NaCl6% HES200/0.5 + 7.2%NaClOpen AAA repairAmount of fluid to restore PCWP
Rao et al. [42], 201711219–60I/IILRS5% dextroseLaparoscopic cholecystectomyIncidence of PONV
Rasmussen et al. [43], 20143364.1 (7.9)26/7I/II/IIILRSDextran 70CystectomyThromboelastogram
Rasmussen et al. [44], 20153768 (61.9–74.3)27/10I/II/IIILRS5% human albuminCystectomyThromboelastogram
Rasmussen et al. [45], 20163969 (66–72)25/14I/II/IIILRS6% HES130/0.4 (Voluven)CystectomyThromboelastogram
Rittoo et al. [46], 20022270.6 ± 2.1815/74% gelatin (Gelofusine)6% HES200/0.62 (Elohes)Open AAA repairSplanchnic perfusion (gastric pH)
Rittoo et al. [47], 20054071.2 (6.7)30/104% gelatin (Gelofusine)6% HES200/0.62 (Elohes)Open AAA repairInflammatory marker
Sander et al. [48], 20035645 ± 15I/II/III (16/36/4)6% HES130/0.4 (Voluven)6% HES200/0.5Major gynecological surgeryHemodynamic maintenance
Senagore et al. [49], 200964I/II/IIIStandard-LRGoal-directed LRGoal-directed hetastarchLaparoscopic colonic surgeryLength of hospital stay
Szturz et al. [50], 201411561 (27–87)83/32I/II/III/IVLRS6% HES130/0.4 (Voluven)Major urological surgeryEfficiency of volume expansion
Vogt et al. [51], 19994865 (7.1)I/II/III (4/33/13)5% human albumin6% HES200/0.5Major urological surgeryHemodynamic stability effect
Waters et al. [52], 20016669.8 ± 8.7I-IV (III)NSSLRSOpen AAA repairChange in base excess
Weinberg et al. [53], 20156063 (38–85)36/24I/II/III (1/26/33)Hartmann solutionPlasmalyteMajor liver resectionImmediate postoperative base excess
Weinberg et al. [54], 20174949 (26–67)33/16NSSPlasmalyteCadaveric kidney transplantPostoperative hyperkalemia 48 hours
Yates et al. [16], 201420272 (56–88)117/85I/II/III/IV (20/119/62/1)Hartmann solution6% HES130/0.4 (Volulyte)Colorectal surgeryGI morbidity at postoperative day 5
Yuan et al. [55], 200812756.1 ± 15.369/58NSS20% human albuminMajor abdominal surgeryAlbumin level
Zhang et al. [56], 20126056.7 ± 6.942/18I/II (32/28)Restricted-LRGoal-directed LRGoal-directed HES130/0.4GI surgeryLength of hospital stay
Zhu et al. [57], 20187173 ± 746/34I/IILRS4% gelatin (Gelofusine)4.5% NaCl in 7.6% HES40Laparoscopic colonic surgerySplanchnic perfusion (gastric pH)

HES = hydroxyethyl starch, LRS = lactated Ringer’s solution, VAS = visual analog scale, BUN = blood urea nitrogen, Cr = creatinine clearance, GFR = glomerular filtration rate, CO = cardiac output, RVEDV = right ventricular end diastolic volume, NSS = normal saline solution, AAA = abdominal aortic aneurysm, PCWP = pulmonary capillary wedge pressure, and PONV = postoperative nausea vomiting.