Effects of Intraoperative Fluid Management on Postoperative Outcomes

Shin, Christina H.; Long, David P.; McLean, Duncan; Grabitz, Stephanie D.; Ladha, Karim; Timm, Fanny P.; Thevathasan, Tharusan; Pieretti, Alberto; Ferrone, Cristina R.; Hoeft, Andreas; Scheeren, Thomas; Thompson, B. Taylor; Kurth, Tobias; Eikermann, Matthias

doi:10.1097/sla.0000000000002220

Cited by 173 publications

(146 citation statements)

References 51 publications

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“…Two recent large observational studies replicated the theoretical U-shaped curve proposed by Bellamy 29 in 2006 and showed that liberal fluid management is associated with more complications. 32,33 For ERPs, fluid excess has also been associated with increased complications and LOS. 34 Since there is no established definition of normovolaemia and fluid requirements vary significantly according to patient and surgical needs, there is also a large body of evidence aimed at individualizing fluid management with GDT.…”

Section: Intraoperative Fluid Managementmentioning

confidence: 99%

“…As previously described, observational data show that there is a U-shaped distribution of risk with excessive fluid restriction also causing harm, particularly with a significant increase in acute kidney injury. 33 So, during high-risk surgery there is a possibility that a restrictive approach could cause harm. There is also evidence to suggest that in the 'real world' fluid management is significantly more chaotic than in the artificially controlled environment of an RCT.…”

Section: Intraoperative Fluid Managementmentioning

confidence: 99%

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Current concepts of fluid management in enhanced recovery pathways

Makaryus

Miller

Gan

2018

British Journal of Anaesthesia

136

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Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients. Preoperative hydration with (complex) carbohydrate drinks up until 2 h before surgery is safe and should be encouraged, as this helps improve metabolism, decrease insulin resistance, reduce anxiety, and reduce nausea and vomiting. During the intraoperative period, the goals of fluid management are to maintain euvolemia using an individualized plan for fluid and haemodynamic management, matching the needs for monitoring with patient and surgical risk through goal-directed therapy (GDT). By combining the use of fluids and inotropes, GDT uses measurements and indicators of cardiac output and stroke volume to improve blood flow intraoperatively, and ultimately reduce LOS and complications. In the postoperative period, an early transition to oral hydration helps to enhance the conditions for healing and recovery from surgery. I.V. fluid therapy should be kept at a minimum, and urine output should not be the driving force for fluid administration. The optimization of perioperative fluid management is critical to ERPs as it helps improve pulmonary function, tissue oxygenation, gastrointestinal motility, and wound healing.

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Section: Intraoperative Fluid Managementmentioning

confidence: 99%

Section: Intraoperative Fluid Managementmentioning

confidence: 99%

Current concepts of fluid management in enhanced recovery pathways

Makaryus

Miller

Gan

2018

British Journal of Anaesthesia

136

View full text Add to dashboard Cite

show abstract

“…Nevertheless, its implementation into clinical practice is not widespread, and even in places where it is used, protocol adherence is hampered by workload, cost issues related to additional monitoring, and skepticism of clinical staff. The consequence is a large inter-and even intra-provider variability in hemodynamic management [25], resulting in varying outcomes [26]. This issue may be resolved by offering clinicians a real-time decision support helping them to decide when and how much volume and vasoactive agents should be given to optimize the patient's hemodynamics.…”

Section: Perioperative Goal-directed Therapymentioning

confidence: 99%

Journal of Clinical Monitoring and Computing end of year summary 2019: hemodynamic monitoring and management

Saugel

Critchley

Kaufmann

et al. 2020

J Clin Monit Comput

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“…While a strictly goal directed volume therapy is widely used for resuscitation of septic patients, 30,31 the amount of fluid given in the peri-operative period is often highly variable. 32 As it is known that volume overload will result in worsening of outcome, 33,34 a recently proposed approach to perioperative fluid therapy was based on the idea of goal directed fluid restriction. 35 This approach led to improved outcome and with regard to the present findings.…”

Section: Color-picturementioning

confidence: 99%

Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs

Behem

Graessler

Pinnschmidt

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS The study provides further insight into the behaviour of intestinal microcirculatory blood flow after ischaemia/ reperfusion injury. The results of the study emphasise that volume therapy should be titrated with meticulous care, particularly after ischaemia/reperfusion injury, and that unnecessary fluid load may impair microcirculatory flow and worsen tissue oedema. Effects on tissue oxygen supply, tissue viability, and patient outcome should be addressed in further studies.Objectives: In the presence of ischaemia/reperfusion (I/R) induced endothelial injury, volume administration may not correlate with increased microcirculation. The aim of this study was to evaluate intestinal microcirculation after standardised sequential volume loading in an animal model of I/R injury following supracoeliac aortic clamping.Methods: This was a prospective exploratory pilot animal study. Intestinal I/R injury was induced in eight pigs during experimental thoraco-abdominal aortic repair. After 6 h of I/R, microcirculatory blood flow (mFlux, measured in the ileum using direct laser speckle contrast imaging) and macrohaemodynamic parameters (using trans-cardiopulmonary thermodilution) were measured and measurements were repeated after each of four sequential volume loading steps (VLS1 e 4). Each load was administered over 5 min followed by another 5 min for equilibration. Results: All animals survived until after VLS4. After 6 h of I/R cardiac output (CO) (p < .001) and mFlux (p < .001) had both decreased. CO increased again after VLS1 (p < .001) and VLS2 (p ¼ .036), whereas mFlux did not change. In contrast, mFlux further decreased after VLS3 (p < .01) and VLS4 (p < .001), whereas CO did not change anymore. Extravascular lung water continued to increase after VLS2 (p ¼ .046) and VLS4 (p ¼ .049). Conclusions: I/R leads to impaired intestinal microcirculation, which was not restored by volume administration in spite of improved CO. In contrast, further volume administration exceeding preload reserves was associated with additional decreases in the intestinal microcirculation. The potentially negative effect of excessive volume resuscitation after I/R injury should encourage further translational research.

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Effects of Intraoperative Fluid Management on Postoperative Outcomes

Abstract: Intraoperative fluid dosing at the liberal and restrictive margins of observed practice is associated with increased morbidity, mortality, cost, and length of stay.

Cited by 173 publications

References 51 publications

Current concepts of fluid management in enhanced recovery pathways

Current concepts of fluid management in enhanced recovery pathways

Journal of Clinical Monitoring and Computing end of year summary 2019: hemodynamic monitoring and management

Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs

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