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Oct 2011

Selection of Bundle Components—Reply

Author Affiliations

Author Affiliation: Department of Surgical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas.

Arch Surg. 2011;146(10):1220-1221. doi:10.1001/archsurg.2011.250

In reply

We appreciate the comments of Drs Hunt and Hopf and their interest in our study.1 Based on a comparison of the median volumes of intraoperative intravenous fluids delivered, Hunt and Hopf have suggested that the algorithm used to guide fluid delivery in the present study1 represented a greater fluid restriction than that used by Brandstrup and colleagues2 in their original work. Whether one fluid delivery algorithm is more restrictive than another cannot be determined solely by the total volume given. Even using a similar algorithm, we found that the volume of fluid delivery will vary according to factors such as the duration of operation and the need to replace blood loss (both of which were less in our study1 than in the study by Brandstrup et al2). Failure to adhere to delivery guidelines can also influence the amount of fluid delivered. In the original study by Brandstrup et al,2 15% of patients received greater than the intended amount of fluid, whereas in our study,1 only 6% of patients received greater than the intended amount of fluid. Thus, the fact that median fluid volume of delivery was less in our study when compared with the study by Brandstrup et al should not be interpreted as evidence of greater fluid restriction.

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