open access

Vol 49, No 5 (2017)
Original and clinical articles
Published online: 2017-11-23
Submitted: 2017-10-17
Accepted: 2017-11-23
Get Citation

Introducing TOPMAST, the first double-blind randomized clinical trial specifically dedicated to perioperative maintenance fluid therapy in adults

Steven Hendrickx, Karen Van Vlimmeren, Ingrid Baar, Walter Verbrugghe, Karolien Dams, Sophie Van Cromphaut, Ella Roelant, Bart Embrecht, Anouk Wittock, Pieter Mertens, Jeroen M. Hendriks, Patrick Lauwers, Paul E. Van Schil, Amaryllis H. Van Craenenbroeck, Tim Van den Wyngaert, Philippe Jorens, Niels Van Regenmortel
DOI: 10.5603/AIT.a2017.0070
·
Pubmed: 29170998
·
Anaesthesiol Intensive Ther 2017;49(5):366-372.

open access

Vol 49, No 5 (2017)
Original and clinical articles
Published online: 2017-11-23
Submitted: 2017-10-17
Accepted: 2017-11-23

Abstract

Background: Although prescribed to every patient undergoing surgery, maintenance fluid therapy is a poorly researched part of perioperative fluid therapy. The tonicity of the chosen solutions, could be an important cause of morbidity, with hyponatremia being a potential side effect of hypotonic solutions, where isotonic solution could lead to fluid overload. Methods: The TOPMAST-trial is an ongoing prospective single-center double-blind randomized trial comparing an isotonic and a hypotonic maintenance fluid strategy during and after surgery in patients undergoing different types of major thoracic surgery. Patients receive NaCl 0.9% in glucose 5% with an added 40 mmol L-1 of potassium chloride or a premixed solution containing 54 mmol L-1 sodium, 55 mmol L-1 chloride and 26 mmol of potassium at a rate of 27 mL per kg of body weight per day. The primary hypothesis is that isotonic maintenance solutions cause a more positive perioperative fluid balance than hypotonic fluids. Different secondary safety endpoints will be explored, especially the effect of the study treatments on the occurrence electrolyte disturbances (e.g. hyponatremia, hyperchloremia) and a set of clinical endpoints. Efficacy endpoints include the need for resuscitation fluids and assessment of renal and hormonal adaptive mechanisms. An anticipated 68 patients will be included between March 2017 and January 2018. Discussion: The study will provide the most comprehensive evaluation of clinically important outcomes associated with the choice of perioperative maintenance fluid therapy.

Abstract

Background: Although prescribed to every patient undergoing surgery, maintenance fluid therapy is a poorly researched part of perioperative fluid therapy. The tonicity of the chosen solutions, could be an important cause of morbidity, with hyponatremia being a potential side effect of hypotonic solutions, where isotonic solution could lead to fluid overload. Methods: The TOPMAST-trial is an ongoing prospective single-center double-blind randomized trial comparing an isotonic and a hypotonic maintenance fluid strategy during and after surgery in patients undergoing different types of major thoracic surgery. Patients receive NaCl 0.9% in glucose 5% with an added 40 mmol L-1 of potassium chloride or a premixed solution containing 54 mmol L-1 sodium, 55 mmol L-1 chloride and 26 mmol of potassium at a rate of 27 mL per kg of body weight per day. The primary hypothesis is that isotonic maintenance solutions cause a more positive perioperative fluid balance than hypotonic fluids. Different secondary safety endpoints will be explored, especially the effect of the study treatments on the occurrence electrolyte disturbances (e.g. hyponatremia, hyperchloremia) and a set of clinical endpoints. Efficacy endpoints include the need for resuscitation fluids and assessment of renal and hormonal adaptive mechanisms. An anticipated 68 patients will be included between March 2017 and January 2018. Discussion: The study will provide the most comprehensive evaluation of clinically important outcomes associated with the choice of perioperative maintenance fluid therapy.
Get Citation

Keywords

maintenance fluid therapy, fluid balance, fluid overload, electrolyte disorders, hyponatremia, hyperchloremia

About this article
Title

Introducing TOPMAST, the first double-blind randomized clinical trial specifically dedicated to perioperative maintenance fluid therapy in adults

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 5 (2017)

Pages

366-372

Published online

2017-11-23

DOI

10.5603/AIT.a2017.0070

Pubmed

29170998

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(5):366-372.

Keywords

maintenance fluid therapy
fluid balance
fluid overload
electrolyte disorders
hyponatremia
hyperchloremia

Authors

Steven Hendrickx
Karen Van Vlimmeren
Ingrid Baar
Walter Verbrugghe
Karolien Dams
Sophie Van Cromphaut
Ella Roelant
Bart Embrecht
Anouk Wittock
Pieter Mertens
Jeroen M. Hendriks
Patrick Lauwers
Paul E. Van Schil
Amaryllis H. Van Craenenbroeck
Tim Van den Wyngaert
Philippe Jorens
Niels Van Regenmortel

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