Preoperative hydration with 0.9% normal saline to prevent acute kidney injury after major elective open abdominal surgery

Serrano, Ana B.; Candela-Toha, Ángel M.; Zamora, Javier; Vera, Jorge; Muriel, Alfonso; Rey, José Manuel del; Liaño, Fernando

doi:10.1097/eja.0000000000000421

Cited by 22 publications

(8 citation statements)

References 30 publications

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“…In severe sepsis, the beneficial effects of timely volume replacement on organ failure and mortality are well known, although the first RCT proving benefit of early volume resuscitation did not report kidney function [47]. On the other hand, preoperative volume expansion failed to reduce the incidence of postoperative AKI ins 328 patients undergoing cardiac surgery [48], and a recent pilot RCT in sepsis could demonstrate that a volume-restrictive fluid protocol can reduced the incidence of AKI (RR 0.32; 95% CI 0.32–0.96) [49]. …”

Section: Volume Expansionmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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Section: Volume Expansionmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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“…The potentially detrimental outcomes, like postoperative oliguria or lactic acidosis were rare in both study groups -possibly because we used uid therapy of similar overall amounts on the operative day. A well performed interventional study aiming to decrease the risk of renal failure by preoperative hydration used a much higher amount of infusion than we did, and also failed to verify the effectiveness of their protocol [35]. The daily intravenous uid regimens in our study can be classi ed 'liberal' as de ned by a meta-analysis from Varadhan et al (>2.75 litres per day) [36], but absolute limits of uid therapy are less useful to distinguish restrictive and liberal protocols, especially when less attention was paid to the estimation of preoperative dehydration in some previous studies.…”

Section: Discussionmentioning

confidence: 80%

Preoperative Ultrasound-based Protocol for Optimisation of Fluid Therapy to Prevent Early Intraoperative Hypotension: A Randomised Controlled Study

Szabó

Pleck

Soós

et al. 2022

Preprint

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Purpose: We aimed to evaluate whether the implication of an ultrasound-based preoperative fluid therapy protocol can decrease the incidence of early intraoperative hypotension. Methods: Randomised controlled study in a tertiary university department involving elective surgical patients of ASA 2-3 class, scheduled for elective major abdominal surgery under general anaesthesia with intubation. We randomized 40–40 patients; 38–38 were available for analysis. Conventional fluid therapy was ordered on routine preoperative visits. Ultrasound-based protocol evaluated the collapsibility index of inferior vena cava and lung ultrasound profiles. Scans were performed twice: 2 h and 30 min before surgery. A high collapsibility index (≥40%) indicated a standardised fluid bolus, while the anterior B-profile of the lung ultrasound contraindicated further fluid. The primary outcome was the incidence of postinduction and early intraoperative (0–10 minutes) hypotension (MAP<65 mmHg and/or ≥30% of decrease from baseline). Secondary endpoints were postoperative lactate level, urine output and lung ultrasound score at 24 h. Results: The absolute criterion of postinduction hypotension was fulfilled in 12 patients in the conventional group (31.6%) and 3 in the ultrasound-based group (7.9%) (p=0.0246). Based on composite criteria, we observed 17 (44.7%) and 7 (18.4%) cases, respectively (p=0.0136). The incidence of early intraoperative hypotension was also lower: HR for absolute hypotension was 2.10 (95%CI 1.00–4.42) in the conventional group (p=0.0387). Secondary outcome measures were similar in the study groups. Conclusion: We implemented a safe and effective point-of-care ultrasound-based preoperative fluid replacement protocol into perioperative care. Trial registration: Clinicaltrials.gov, NCT05171608 (registered prospectively on 10/12/2021)

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“…This approach may prevent postoperative complications, such as hypotension and acute kidney injury, and thus potentially reduce surgical morbidity and mortality. 20…”

Section: Recommendationsmentioning

confidence: 99%

Preoperative Oral Hydration Is Safe in Rapid Recovery Total Hip Arthroplasty

Anoushiravani

Singh

Feng

et al. 2021

The Journal of Hip Surgery

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Fluid and food restrictions prior to surgery are thought to reduce the risk for perioperative aspiration pneumonia. However, the recent anesthesia literature suggests that clear fluids up to 2 hours before surgery may be tolerated. Here we investigate the safety and efficacy of a standardized hydration protocol among same-day discharge total hip arthroplasty (SDD-THA) candidates. All patients scheduled to undergo primary SDD THA between January 2017 and October 2018 were included. Surgical recipients between January 2017 and August 2017 were used as historical controls. Surgical recipients between September 2017 and October 2018 participated in the hydration initiative which allowed for the consumption of 32 oz of clear fluid 2 hours prior to surgery. Baseline demographics and quality metrics were prospectively collected and analyzed to define the impact of a hydration protocol in SDD THA. In total, 585 consecutive SDD-THA candidates were included in this study, of which 309 and 276 patients were in the control and hydration cohorts, respectively. Univariable analysis of postoperative outcomes demonstrated that a similar number of THA recipients failed SDD (7.44 vs. 7.97%; p = 0.88); however, a clinically meaningful reduction in hypotensive episodes was observed among the hydration cohort (0.4 vs. 1.9%; p = 0.08). Multivariable regression demonstrated similar outcomes after controlling for all collected patient risk factors (odds ratio 0.95; 95% confidence interval 0.48–1.88; p = 0.89). Our study suggests hydration protocols are safe and may reduce the clinical incidence of postoperative hypotension when compared with standard nil per os restrictions. Future studies are needed to better elucidate the role of perioperative hydration before THA. The level of evidence of the study is level II, prospective observational cohort.

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Preoperative hydration with 0.9% normal saline to prevent acute kidney injury after major elective open abdominal surgery

Abstract: Clinical trials.gov: NCT00953940 and EUDRA CT: 2005-004755-35.

Cited by 22 publications

References 30 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Preoperative Ultrasound-based Protocol for Optimisation of Fluid Therapy to Prevent Early Intraoperative Hypotension: A Randomised Controlled Study

Preoperative Oral Hydration Is Safe in Rapid Recovery Total Hip Arthroplasty

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