Positive Fluid Balance is Associated with Complications after Elective Open Infrarenal Abdominal Aortic Aneurysm Repair

McArdle, G.T.; Price, Gareth; Lewis, A. A. M.; Hood, John; McKinley, A.; Blair, Paul; Harkin, Denis W.

doi:10.1016/j.ejvs.2007.03.010

Cited by 54 publications

(10 citation statements)

References 35 publications

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“…If emergency cases were included, as in ours, the mortality rate was 7.3 % 3. Morbidity rates were reported as 37%7 and 40% 5. These results were in line with ours.…”

Section: Discussionsupporting

confidence: 86%

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Risk Factors for Postoperative Complications after Open Infrarenal Abdominal Aortic Aneurysm Repair in Koreans

et al. 2011

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PurposeOpen infrarenal abdominal aortic aneurysm (AAA) repair is performed without event in most cases. However, some patients suffer major morbidities such as renal failure, myocardial infarction, paraplegia, acute respiratory distress syndrome, or hepatic dysfunction. Predicting what kinds of patient populations are more prone to develop such complications may keep the clinicians more attentive to the patients, possibly leading to better prognoses. In this retrospective study, we searched the incidence of and risk factors for postoperative complications and their predictive equations in 162 patients who underwent open infrarenal AAA repair.Materials and MethodsPostoperative complications were observed within 30 days. Patient characteristics, types of aneurysm and surgery, and hemodynamic and metabolic variables during the periclamp period were analyzed in relation to postoperative complications using multiple logistic regression analysis.ResultsPostoperative complications involved the cardiac (20%), pulmonary (14%), renal (13%), gastrointestinal (6%), hepatic (3.1%), and neurologic (2.5%) systems, and bleeding occurred in 1.2% of cases. The mortality rate was 5.6%. The risk factors were age [> 67 yrs, odds ratio (OR) 2.6], clamp duration (> 110 min, OR 4.7), volume of blood transfusion (> 1,280 mL, OR 4.4), emergency operation (OR 1.4), and vasopressor infusion during clamp (OR 1.4). The prediction model was: P(x) = exp(α)/[1 + exp(α)] α;-2.2 + 0.9 × age + 1.5 × clamp duration + 1.5 × transfusion + 0.3 × emergency + 0.4 × vasopressor infusion [insert 1 if risk factors exist, otherwise, insert 0 to each variable].ConclusionA significant number of complications occurred after infrarenal AAA repair. Therefore, creating a protocol to identify and monitor high risk patients would improve postoperative care.

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“…If emergency cases were included, as in ours, the mortality rate was 7.3 % 3. Morbidity rates were reported as 37%7 and 40% 5. These results were in line with ours.…”

Section: Discussionsupporting

confidence: 86%

“…In previous reports, mortality rates for elective infrarenal AAA repair were 0%,5 2.5%,6 and 3.1% 7. If emergency cases were included, as in ours, the mortality rate was 7.3 % 3.…”

Section: Discussionmentioning

confidence: 84%

Risk Factors for Postoperative Complications after Open Infrarenal Abdominal Aortic Aneurysm Repair in Koreans

et al. 2011

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“…Clearly, for acute lung injury, a positive fluid balance has been shown to increase the time spent on mechanical ventilation and to trend toward increased mortality 27 , while a negative cumulative fluid balance at day 4 was associated with significantly lower mortality 28 . In surgical patients, a restricted intravenous fluid regimen significantly reduced postoperative complications 29 , and vice-versa, a positive fluid balance was associated with complications after elective open infrarenal abdominal aortic aneurysm repair 30 .…”

Section: Discussionmentioning

confidence: 97%

Intravenous Fluid Challenge Decreases Intracellular Volume: A Bioimpedance Spectroscopy-Based Crossover Study in Healthy Volunteers

Ernstbrunner

Kabon

Zotti

et al. 2017

Sci Rep

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The effects of intravenous fluid therapy on fluid compartments and hemodynamics of the human body remain enigmatic. We therefore tested the efficacy of bioimpedance spectroscopy in a crossover study, where 15 males received 0.5 ml/kg/min ELO-MEL-isoton (osmolarity = 302 mosmol/l) during 60 minutes, or nothing at all. In group “Fluid”, fluid load increased from −0.2 ± 1.0 l extracellular volume at baseline to its maximum of 1.0 ± 0.9 l in minute 70, and remained continuously elevated throughout minute 300. In group “Zero”, fluid load decreased from 0.5 ± 1.1 l at baseline to its minimum of −1.1 ± 1.1 l in minute 300. In group “Fluid”, intracellular volume decreased from 26.8 ± 3.9 l at baseline to its minimum of 26.0 ± 3.9 l in minute 70, and remained continuously decreased throughout minute 300. In group “Zero”, intracellular volume increased from 26.5 ± 3.8 l at baseline to its maximum of 27.1 ± 3.9 l in minute 120, and decreased thereafter. In group “Fluid” compared to “Zero”, systolic blood pressure was significantly higher, from minute 50–90. In conclusion, intravenous fluid therapy caused a clinically meaningful, sustained increase in fluid load, and a decrease in intracellular volume. These data raise interest in studying fluid administration by the gastrointestinal route, perhaps even when managing critical illness.

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“…Our results support a targeted preload optimisation strategy, which needs less fluid loading than described in previous reports [9], and which is sufficient to attenuate the decrease in CO induced by the prone position. As undifferentiated fluid management has been reported to worsen postoperative morbidity [10, 11], complications may be avoided by a more precise fluid strategy with SVV‐guided optimisation.…”

Section: Discussionmentioning

confidence: 99%

Does targeted pre‐load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position

Wu¹,

Lee²,

Chan³

et al. 2012

Anaesthesia

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SummaryThe prone position can reduce cardiac output by up to 25% due to reduced preload. We hypothesised that preload optimisation targeted to stroke volume variation before turning prone might alleviate this. A supine threshold stroke volume variation of 14% in a preliminary study identified patients whose cardiac outputs would decline when turned prone. In 45 patients, cardiac output declined only in the group whose supine stroke volume variation was high (mean (SD) 5.1 (2.0) to 3.9 (1.9) l.min )1 ; p < 0.001), but not in patients in whom it was low, or in those in whom stroke volume variation was high, but who received volume preload (p = 0.525 and 0.941, respectively). We conclude that targeted preload optimisation using a supine stroke volume variation value < 14% is effective in preventing falls in cardiac output induced by the prone position. A reduction in cardiac output (CO) by up to 25% of baseline while turning surgical patients from supine to prone positions has been reported and this is due to a reduction in preload in this position [1]. Although volume status plays an important role, pre-operative optimisation of preload, to alleviate the decrease in CO in the prone position, may not be feasible by conventional static monitoring such as central venous pressure [2]. The use of stroke volume variation (SVV) has been shown to be a reliable indicator of fluid responsiveness in both supine and prone positions [3]. Therefore, we hypothesised that pre-operative preload optimisation guided by SVV may be effective in alleviating the decline in CO induced by turning prone.In a preliminary study, we first tried to define the threshold SVV in the supine position that would predict which patients would or would not experience a reduction in CO on turning prone. Then in the substantive study, we examined the effectiveness of preload optimisation in preventing the prone positioninduced decline in CO. MethodsAfter approval from the institutional review board and written informed consent, an observational pilot study of 30 patients receiving lumbar spine surgery was conducted to estimate the threshold SVV value in the supine position that was predictive of a prone positioninduced 25% decline in CO. The surgical and anaesthesia protocols for this pilot study were the same as for the main study (see below). We found that a 14% supine SVV predicted a decline in CO with a sensitivity of 100% (95% CI 60-100), specificity of 78% (95% CI 56-93) and area under the receiver operator-characteristic (ROC)

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Positive Fluid Balance is Associated with Complications after Elective Open Infrarenal Abdominal Aortic Aneurysm Repair

Abstract: Serious complications are common after elective open AAA repair, and we have shown that positive fluid balance is predictive of major adverse events increased HDU/ICU and overall hospital stay.

Cited by 54 publications

References 35 publications

Risk Factors for Postoperative Complications after Open Infrarenal Abdominal Aortic Aneurysm Repair in Koreans

Risk Factors for Postoperative Complications after Open Infrarenal Abdominal Aortic Aneurysm Repair in Koreans

Intravenous Fluid Challenge Decreases Intracellular Volume: A Bioimpedance Spectroscopy-Based Crossover Study in Healthy Volunteers

Does targeted pre‐load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position

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