Goal-Directed Fluid Therapy vs. Low Central Venous Pressure during Major Open Liver Resections (GALILEO): A Surgeon- and Patient-Blinded Randomized Controlled Trial

Abstract Background Low central venous pressure (low-CVP) is the clinical standard for fluid therapy during major liver surgery. Although goal-directed fluid therapy (GDFT) has been associated with reduced morbidity and mortality in major abdominal surgery, concerns remain on blood loss when applying GDFT in liver surgery. This randomized trial compared outcomes of low-CVP and GDFT during major liver resections. Methods In this surgeon- and patient-blinded RCT, patients undergoing major open liver resections (≥3 segments) were randomized between low-CVP (n=20) or GDFT (n=20). Primary outcome was intraoperative blood loss. Secondary outcomes included the quality of the surgical field (VAS scale 0 (worst)-100 (best)) and major morbidity (≥grade 3 Clavien-Dindo). Results During surgery, CVP was 3±2 mmHg in the low-CVP group vs. 7±3 mmHg in the GDFT group (P Conclusions In major open liver resections, GDFT was not associated with differences in intraoperative blood loss, major morbidity or quality of the surgical field, compared to low-CVP. Larger RCTs are needed to confirm this finding. Registration number: NTR5821 ( www.trialregister.nl )