Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Pipanmekaporn, Tanyong; Punjasawadwong, Yodying; Charuluxananan, Somrat; Lapisatepun, Worakitti; Bunburaphong, Pavena; Saeteng, Somchareon

doi:10.2147/rmhp.s64585

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…The strength of this study is the demonstration that the fluid accumulation threshold is based on the individual patient’s body size instead of being a fixed amount of fluid. 7 , 27 This study also verified the lower cutoff threshold, as compared with previous studies, that impacts surgical ICU outcomes. 6 , 12 However, our study had some limitations.…”

Section: Discussionsupporting

confidence: 84%

“… 6 However, recent evidence found that a positive fluid balance of more than 2,000 mL (approximately 4%–7% of dry weight) during the intraoperative period was a strong risk factor for cardiovascular complications in thoracic surgical patients. 7 Nonetheless, to date, there has been little evidence to demonstrate the threshold for concern and influence of fluid accumulation on outcomes, especially in high risk and critically ill surgical patients. 6 In addition, accurate fluid output was difficult to measure in some surgical patients because of multiple drains, wounds, and insensible loss.…”

Section: Introductionmentioning

confidence: 99%

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Fluid accumulation threshold measured by acute body weight change after admission in general surgical intensive care units: how much should be concerning?

Chittawatanarat¹,

Pichaiya²,

Chandacham³

et al. 2015

TCRM

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BackgroundThe objective of this study (ClinicalTrials.gov: NCT01351506) was to identify the threshold level of fluid accumulation measured by acute body weight (BW) change during the first week in a general surgical intensive care unit (ICU), which is associated with ICU mortality and other adverse outcomes.MethodsFour hundred sixty-five patients were prospectively followed for a 28-day period. The maximum BW change threshold during the first week was evaluated by the maximum percentage change in BW from the ICU admission weight (Max%ΔBW). Daily screening of adverse events in the ICU were recorded. The cutoff point of Max%ΔBW on ICU mortality was defined by considering the area under the receiver operating characteristic (ROC) curve, intersection of the sensitivity and specificity, and the Youden Index. Univariable and multivariable regression analyses were used to demonstrate the associations. Statistical significance was defined as P<0.05.ResultsThe appropriate cutoff value of Max%ΔBW threshold was 5%. Regarding the multivariable regression model, in overall patients, the occurrence of the following adverse events (expressed as adjusted odds ratio [95% confidence interval]) were significantly associated with a Max%ΔBW of >5%: ICU mortality (2.38 [1.25–4.54]) (P=0.008), ICU mortality in patients without renal replacement therapy (RRT) (2.47 [1.21–5.06]) (P=0.013), reintubation within 72 hours (2.51 [1.04–6.00]) (P=0.039), RRT requirement (2.67 [1.13–6.33]) (P=0.026), and delirium (1.97 [1.08–3.57]) (P=0.025). Regarding the postoperative subgroup, a Max%ΔBW value of more than 5% was significantly associated with: ICU mortality (3.87 [1.38–10.85]) (P=0.010), ICU mortality in patients without RRT (6.32 [1.85–21.64]) (P=0.003), reintubation within 72 hours (4.44 [1.30–15.16]) (P=0.017), and vasopressor requirement (2.04 [1.04–4.01]) (P=0.037).ConclusionFluid accumulation, measured as acute BW change of more than the threshold of 5% during the first week of ICU admission, is associated with adverse outcomes of higher ICU mortality, especially in the patients without RRT, with reintubation within 72 hours, with RRT requirement, with vasopressor requirement, and with delirium. Some of these effects were higher in postoperative patients. This threshold value might be an indicator for caution during fluid management in surgical ICU.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Fluid accumulation threshold measured by acute body weight change after admission in general surgical intensive care units: how much should be concerning?

Chittawatanarat¹,

Pichaiya²,

Chandacham³

et al. 2015

TCRM

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show abstract

“…Moreover, Pipanmekaporn et al 16 reported an incidence of 6.7% (48 patients) for cardiovascular complications in a study of 720 patients undergoing thoracotomy for indications other than cancer. The rate of cardiovascular complications was 22.2% in patients with a positive fluid balance of >2,000 mL and 7.0% in patients with a fluid balance of ≤2,000 mL ( p =0.005).…”

Section: Discussionmentioning

confidence: 99%

Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery

Şahutoğlu

Türksal

Kocabas

et al. 2018

TCRM

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BackgroundFluid management in critically ill patients usually relies on increasing preload to augment cardiac output. In the present study, we aimed to evaluate whether stroke volume variation (SVV) can guide fluid therapy and reduce complications.Patients and methodsIn this retrospective study, a total of 88 patients who underwent lobectomy were divided into two groups: group 1 (SVV, n=43) and group 2 (conventional or central venous pressure [CVP], n=45). Heart rate, blood pressure, oxygen saturation, SVV (only group 1), CVP (all patients), urea, creatinine, and hemoglobin levels before and after surgery, use of fluid, blood and inotropic agents, and postoperative complications were recorded retrospectively.ResultsThe mean age of the study population was 56.9±14.4 years and 75% of the patients were male. SVV was used in fluid therapy in 48.9% of the patients. The use of SVV resulted in an increased use of crystalloids and colloids with increased urine output per hour (p<0.05). Of patients in the SVV group and the CVP group, 44.1% and 51.1% developed at least one complication, respectively (p=0.531). The rate of respiratory complications including atelectasis, pneumonia, hypoxemia, and an increased production of secretions was 21% in the SVV group and 37.7% in the CVP group (p=0.104). The rate of complications and the length of hospital stay were comparable between the groups (p>0.05).ConclusionOur study results showed that the use of SVV increased the use of crystalloids and colloids and favorably affected urine output per hour but did not reduce complications in thoracic surgery.

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Growing Evidence for Hyperoncotic 20% Albumin Solution for Volume Resuscitation

Haynes

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Association of positive fluid balance and cardiovascular complications after thoracotomy for noncancer lesions

Cited by 4 publications

References 33 publications

Fluid accumulation threshold measured by acute body weight change after admission in general surgical intensive care units: how much should be concerning?

Fluid accumulation threshold measured by acute body weight change after admission in general surgical intensive care units: how much should be concerning?

Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery

Growing Evidence for Hyperoncotic 20% Albumin Solution for Volume Resuscitation

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