Perioperative fluid and hemodynamic management within an enhanced recovery pathway

Manning, Michael W.; Dunkman, W. Jonathan; Miller, Timothy E.

doi:10.1002/jso.24828

Cited by 16 publications

(15 citation statements)

References 87 publications

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“…Prevailing evidence from our research group and others, has led to the notion of the "protocolised" perioperative "fluid-restrictive" approach [28][29][30] in order to reduce postoperative morbidity, including AKI. In this regard, our findings are consistent with the existing evidence reinforcing a strong association between fluid volume [31][32][33][34][35][36][37] and chloriderich fluid type [38][39][40][41] , and risk of AKI.…”

Section: Relationship With Previous Studiesmentioning

confidence: 99%

Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

Weinberg

Чурилов

et al. 2018

Anaesth Intensive Care

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Fluid administration has been reported to be associated with an increased risk of acute kidney injury (AKI). We assessed whether, after correction for fluid balance, amount and chloride content of fluids administered have an independent association with AKI. We performed an observational study in patients after major surgery assessing the independent association of AKI with volume, chloride content and fluid balance, after adjustment for Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) score, age, elective versus emergency surgery, and duration of surgery. We studied 542 consecutive patients undergoing major surgery. Of these, 476 patients had renal function tested as part of routine clinical care and 53 patients (11.1%) developed postoperative AKI. After adjustments, a 100 ml greater mean daily fluid balance was artificially associated with a 5% decrease in the instantaneous hazard of AKI: adjusted Hazard Ratio (aHR) 0.951, 95% confidence intervals (CI) 0.935 to 0.967, P <0.001. However, after adjustment for the proportion of chloriderestrictive fluids, mean daily fluid amounts and balances, POSSUM morbidity, age, duration and emergency status of surgery, and the confounding effect of fluid balance, every 5% increase in the proportion of chloride-liberal fluid administered was associated with an 8% increase in the instantaneous hazard of AKI (aHR 1.079, 95% CI 1.032 to 1.128, P=0.001), and a 100 ml increase in mean daily fluid amount given was associated with a 6% increase in the instantaneous hazard of AKI (aHR 1.061, 95% CI 1.047 to 1.075, P <0.001). After adjusting for key risk factors and for the confounding effect of fluid balance, greater fluid administration and greater administration of chloride-rich fluid were associated with greater risk of AKI.

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Section: Relationship With Previous Studiesmentioning

confidence: 99%

Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

Weinberg

Чурилов

et al. 2018

Anaesth Intensive Care

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“…The combined physiologic effects of prone positioning and the risk of substantial blood loss pose patients undergoing multilevel spine surgery at high risk for intraoperative hemodynamic instability. GDFT is described as an approach to guide perioperative fluid administration in order to avoid fluid overload, organ hypoperfusion, hypoxia, and hypovolemia ( 35 , 36 ). This volume replacement strategy has been associated with more positive post-operative outcomes such as enhanced post-operative recovery and reduced length of hospital stay, occurrence of acute renal injury and infections ( 37 – 44 ).…”

Section: Physiologic Changes During Prone Positioningmentioning

confidence: 99%

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

et al. 2020

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Fluid management has been widely recognized as an important component of the perioperative care in patients undergoing major procedures including spine surgeries. Patient-and surgery-related factors such as age, length of the surgery, massive intraoperative blood loss, and prone positioning, may impact the intraoperative administration of fluids. In addition, the type of fluid administered may also affect post-operative outcomes. Published literature describing intraoperative fluid management in patients undergoing major spine surgeries is limited and remains controversial. Therefore, we reviewed current literature on intraoperative fluid management and its association with post-operative complications in spine surgery.

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“…A recent clinical trial found significantly less neurologic and renal injury when patients were maintained at their target BP rather than at a standard BP . Precision medicine is also seen in the implementation of enhanced recovery pathways, including continuous hemodynamic and oxygen delivery monitoring to mitigate organ ischemia through goal‐directed fluid therapy and/or the addition of inotropes or vasopressors while minimizing fluid overload …”

Section: Perspectives On Precision Medicine By Prnmentioning

confidence: 99%

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

Caudle

Gammal

Karnes

et al. 2019

J Am Coll Clin Pharm

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Clinical pharmacists have been incorporating precision medicine into practice for decades. Drug selection and dosing based on patient‐specific clinical factors such as age, weight, renal function, drug interactions, plasma drug concentrations, and diet are expected as part of routine clinical practice. Newer concepts of precision medicine such as pharmacogenomics have recently been implemented into clinical care, while other concepts such as epigenetics and pharmacomicrobiomics still predominantly exist in the research area but clinical translation is expected in the future. The purpose of this paper is to describe current and emerging aspects of precision medicine as it relates to clinical pharmacy across a variety of specialty areas of practice, with perspectives from the American College of Clinical Pharmacy Practice and Research Network membership.

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Perioperative fluid and hemodynamic management within an enhanced recovery pathway

Cited by 16 publications

References 87 publications

Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

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