Do Large Clinical Trials Adequately Consider Individual Patient Physiology? Debating The RELIEF Study

By Michael Keane, BMBS, FANZCA and Shashikanth Manikappa, MD, DNB, FANZCA
February 21, 2019

Patient safety requires a well-informed debate about the rationale of large, randomized controlled trials (RCTs) and whether, by their very nature, they can adequately consider the unique physiology of every individual patient. 

RCTs must be reproducible; the fundamental premise of any scientific experiment. In their day-to-day practice, clinicians must, therefore, be willing to reproduce the same treatment of individual patients’ physiology. If clinicians would treat individual patients (including physiological outliers) differently to that in which individual patients were treated in a trial, then that trial data becomes meaningless to their practice.  Continue reading “Do Large Clinical Trials Adequately Consider Individual Patient Physiology? Debating The RELIEF Study”

Restrictive versus Liberal Fluid Therapy in Abdominal Surgery

By Connor Emdin
August 28, 2018

Abdominal surgery can result in significant fluid loss, arising from multiple sources, including fasting prior to surgery, evaporation during surgery, from blood loss and from other sources.1 Traditionally, individuals undergoing abdominal surgery received liberal fluid resuscitation (up to 7L on the day of surgery) which frequently exceeded their losses and led to weight gain of 3-6kg.2 Excessive fluid loading can lead to elevated rates of postoperative heart failure, arrhythmias, and wound infection due to local tissue edema, and in small clinical trials, restrictive hydration strategies (targeting net zero fluid balance) have been associated with fewer complications than liberal fluid replacement.3 Consequently, clinical guidelines now recommend more restrictive fluid therapy for abdominal surgery.4,5 Continue reading “Restrictive versus Liberal Fluid Therapy in Abdominal Surgery”