Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy

Yu, Wenkui; Li, Ning; Gong, Jianfeng; Li, Weiqin; Tang, Shaoqiu; Tong, Zhihui; Gao, Tao; Zhang, Juanjuan; Xi, Fengchan; Shi, Hui; Zhu, Weiming; Li, Jieshou

doi:10.1016/j.surg.2009.10.036

Cited by 82 publications

(59 citation statements)

References 27 publications

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“…Also, pursuing lactate normalization at all costs in the absence of other signs of tissue hypoperfusion may expose patients to the toxicity of over-resuscitation without any clear benefit. Nevertheless, lactate-driven adjustment of intravenous fluid administration intraoperatively and in the early postoperative period allowed early detection and correction of inadequate tissue perfusion and significantly decreased the overall complication rate after elective surgery for GI malignancy (15).…”

Section: Commentarymentioning

confidence: 99%

Lactate: the Black Peter in high-risk gastrointestinal surgery patients

et al. 2016

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Section: Commentarymentioning

confidence: 99%

Lactate: the Black Peter in high-risk gastrointestinal surgery patients

et al. 2016

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“…Several studies have examined the effects of liberal or restrictive fluid regimes on postoperative outcomes and conflicting results have been obtained [4][5][6][7][8][9][10][11]43]. Some studies have shown a benefit with a restrictive approach whilst others favour more liberal fluid administration.…”

Section: Liberal Versus Restricted Fluid Therapymentioning

confidence: 99%

“…Little research has been carried out on using these measures of tissue perfusion as therapeutic goals to guide haemodynamic therapy [5]. Certainly there is a well recognised association between abnormal values and worse post operative outcome [65,66], and they are frequently reported as surrogates for outcome in major gastrointestinal surgery [67].…”

Section: Lactate and Base Deficitmentioning

confidence: 99%

“…This dynamic relationship was described by Bellamy as a U-shaped curve comparing complications with administered fluid volumes in the perioperative period and highlighted the relative dangers of hypo-and hypervolaemia [3]. The challenge, however, is to find the ideal amount of fluid for each individual patient, and various techniques have been suggested ranging from liberal or restrictive fluid regimes [4][5][6][7][8][9][10][11], zero balance in the perioperative period [12], and fluid optimisation either targeting oxygen delivery or maximising strove volume [13][14][15][16][17][18][19][20]. In addition there has been much interest into the effect of the type of fluid administered and its effects on postoperative outcomes [21,22 • , 23 • , 24].…”

Section: Introductionmentioning

confidence: 99%

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Volume Management and Resuscitation in Colorectal Surgery

Yates

Davies

Warnakulasuriya

et al. 2014

Curr Anesthesiol Rep

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The maintenance of intravascular volume during and after colorectal surgery is important in the optimization of perioperative outcomes. Techniques for optimizing cardiac output using minimally invasive monitoring have been studied extensively with many authorities now advocating some form of intraoperative stroke volume optimization. The excess administration of crystalloid solutions causes significant postoperative morbidity yet recent trials investigating the optimal type of fluid to be used have failed to show any benefit from the administration of colloids over crystalloids. Saline-based fluids are known to cause metabolic disturbance in the form of hyperchloraemia and acidosis but until recently no outcome data on their use was available. Large-scale observational studies now suggest that balanced solutions carry significant benefits when compared to saline-based solutions. This article reviews the recent literature describing the controversies in perioperative fluid management in colorectal surgery.

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“…However, in states of high vascular permeability, like sepsis, or even positive pressure ventilation, the fluid administered rapidly goes into the extravascular space, contributing to peripheral edema and not to the increase in intravascular volume. As the organ edema can contribute to end-organ dysfunction, including a delay in renal function recovery, the excessive fluid administered is harmful, and not a part of any therapeutic strategy [28][29][30][31][32] .…”

Section: Monitoring Devicesmentioning

confidence: 99%

Diagnostic tools and therapeutic end-points in critical care medicine: Limitations and concepts

Severino

Marum²,

Marcelino

2014

JNEP

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In Intensive Care Medicine (ICM) the presence of multiple high tech devices is common in order to perform multiple medical and non-medical procedures. The authors intend to perform a critical appraisal on the basic and practical/clinical approach to monitoring devices, analyzing the evidence support regarding clinical effects, end-points, and patient safety. All data that provides a diagnosis or a characterization of the patient's status will be considered diagnostic information whereas, variables that could be achieved by medical interventions will be considered therapeutic end-points. In any healthcare setting a careful approach to the patient is needed, namely in ICM one must consider the patient's clinical condition and choose adequate diagnostic tools and devices. Not all variables and devices currently on the market are suitable for each patient, nor proved useful in the setting under study. Also, all patients are different and must be approached differently according to established clinical end-points, translating into more holistic caregiving. ICM requires a personalized approach towards the patient, consequently, submitting diagnostic tools and monitoring devices to greater scrutiny in order to obtain greater patient benefit.

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Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy

Cited by 82 publications

References 27 publications

Lactate: the Black Peter in high-risk gastrointestinal surgery patients

Lactate: the Black Peter in high-risk gastrointestinal surgery patients

Volume Management and Resuscitation in Colorectal Surgery

Diagnostic tools and therapeutic end-points in critical care medicine: Limitations and concepts

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