Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients

Gyökeres, T; Marjanek, Z; Ulakcsai, Z; Zsuzsanna, Szabó; Bogár, Lajos; Károlyi, Mária; Gartner, Béla; Kiss, Katalin É.; Havas, Attila; Futó, Judit

doi:10.1097/eja.0b013e32833b3504

Cited by 67 publications

(44 citation statements)

References 36 publications

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“…Similar results (crystalloid: colloid; 1:1.45) were noted in septic patients in the VISEP study where the goals of hemodynamic optimization were adjustments in HR, MAP, CVP and mixed venous oxygen saturation (5,20). Nevertheless, a recent study performed in an early postoperative period showed that while using the same amounts of different solutions, colloids are more effective in increasing cardiac fi lling, output and oxygen delivery than administration of Ringer's solution (21). Interaction between amounts of administered fl uid and vasoactive agents was not evaluated.…”

Section: Discussionmentioning

confidence: 99%

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

Szturz¹,

Kula²,

Tichy³

et al. 2014

BLL

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Background:The impact of different approaches to fl uid management during intraoperative volume resuscitation in patients undergoing major elective surgery is poorly defi ned. We compared volume effectiveness of crystalloid and colloid substitution aimed to maintain the cardiac index (CI) between 2.6 and 3.8 l/min/ m 2 as measured by transesophageal Doppler (TED). Methods: A total of 115 urological patients were enrolled in the prospective randomized trial and then randomized into 2 groups, one with volume therapy based on crystalloids (n = 57) and the other with colloids (n = 58). A TED probe was inserted and then hemodynamic optimization (therapy with Ringer's solution or hydroxyethyl starch 6 % 130/0.4 and administration of vasoactive drugs) was started according to TED variables to maintain the CI between 2.6 and 3.8 l/min/m 2 . Results: We observed high incidence of CI < 2.6 l/min/m 2 after induction of anesthesia (75 %) in both groups. There were no signifi cant differences in demographic characteristics, ASA classifi cation, length of surgery, estimated blood loss and the CI during surgery. To maintain the CI within the requested interval, signifi cantly different amounts of crystalloids were needed as compared to colloid (median: 5000 ml vs 1500 ml). In the CRY group, more patients were treated by vasodilatators (40.4 vs 20.7 %). Conclusions:The study confi rmed that crystalloids and colloids are effective in correcting fl ow-related perfusion abnormalities. The signifi cant difference between volumes of crystalloids and colloids proved their different characteristics such as unequal distribution between compartments. The expansion of therapeutic algorithm by using vasoactive drugs allows us to avoid adverse events resulting from fl uid overload (Tab. 1, Fig. 5, Ref. 35). Text in PDF www.elis.sk.

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Section: Discussionmentioning

confidence: 99%

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

Szturz¹,

Kula²,

Tichy³

et al. 2014

BLL

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“…Direct comparison of 6% HES 130/0.4 and 5% human albumin in adult surgical patients is scarce. Gondos et al (2010) [10] compared the hemodynamic effects of 6% HES 130/0.4, 5% human albumin, 4% gelatin and Ringer's lactate in a fluid challenge with 10 ml/kg infused within 30 minutes in postoperative hypovolemic patients. They concluded that the hemodynamic effects of 6% HES 130/0.4 were at least similar to 5% human albumin.…”

Section: In Patients Undergoingmentioning

confidence: 99%

The Volume Effect and Safety of 6% Hydroxyethyl Starch 130/0.4 in Patients Undergoing Major Elective Surgery: An Uncontrolled, Open-Labeled, Multi-Center Study

Morioka¹,

Ozaki²,

Yamakage³

et al. 2013

OJAnes

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Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need to infuse human albumin may be reduced or avoided in Japan if these large doses 6% HES 130/0.4 can be infused. Methods: The study was an uncontrolled, open-labeled, multi-center trial. Fifteen adult and 5 pediatric patients undergoing major elective surgery received 6% HES 130/0.4 (Voluven ® ) with a maximum dose of 50 mL/kg from the start of surgery until 2 hours after the end of surgery according to a treatment algorithm. The primary efficacy endpoint was the volume effect of 6% HES 130/0.4 determined by the volume of saved albumin during the investigational period and the time course of hemodynamic stability in adult and pediatric patients. Safety parameters were fluid balance, hemodynamic and laboratory parameters ECG, local and systemic tolerance and adverse events. Results: Adult patients received a mean of 32.0 mL/kg of 6% HES 130/0.4. For 12 out of 15 adult patients an average amount of 1033.8 mL (18.6 mL/kg) albumin could be saved. The other 3 adult patients did not receive more than 1000 mL of HES 130/0.4. All pediatric patients received approximately 50 mL/kg of HES 130/0.4; for these patients an average amount of 39.9 mL/kg body weight albumin could be saved. The majority of adult patients, and all pediatric patients were hemodynamically stable at all 3 time points. The observed changes of the assessed laboratory parameters including hematological and coagulation parameters or in any other safety parameter determined did not reveal any safety concern related to the administration of 6% HES 130/0.4 up to doses of 50 mL/kg body weight. Conclusion: The study results indicate that 6% HES 130/0.4 has a reliable volume effect, could contribute to significant human albumin savings and was safe and well tolerated up to a maximum dose of 50 mL/kg body weight in adult and pediatric patients undergoing major elective surgery.

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“…This syndrome has been reported to cause a high incidence of morbidity and mortality, involving up to 90 % of the affected patients, depending on the extent of the involved lung regions [9][10][11][12][13]. Inhalation of the gastric contents into the lower respiratory tract induces a number of pulmonary syndromes, described originally by Mendelson et al, including acute aspiration pneumonitis caused by the acidity subsequent to chemical injury [14], and aspiration pneumonia resulting from the inhalation of pathogenic bacteria [7,8,15].…”

Section: Aspiration As Source Of Respiratory Morbiditymentioning

confidence: 99%

“…Among the respiratory adverse effects during anaesthesia and intensive care, bronchoaspiration poses a major challenge for health professionals [7,8]. This syndrome has been reported to cause a high incidence of morbidity and mortality, involving up to 90 % of the affected patients, depending on the extent of the involved lung regions [9][10][11][12][13].…”

Section: Aspiration As Source Of Respiratory Morbiditymentioning

confidence: 99%

“…4 Crystalloids remain a rational option, but clinicians are reluctant to choose them because of the widespread belief that they move rapidly out of the circulation, a belief based on old studies that lacks an adequate evidence basis. [5][6][7] We have recently shown that acute hypovolaemic shock and subsequent resuscitation with autologous blood affects respiratory mechanics. 8 Although surgical procedures are associated with a more controlled but sustained blood loss that also requires fluid replacement therapy, the respiratory consequences of this have not been explored.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory consequences of perioperative complications related to anaesthesia

Fodor¹

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Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients

Cited by 67 publications

References 36 publications

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

Individual goal-directed intraoperative fluid management of initially hypovolemic patients for elective major urological surgery

The Volume Effect and Safety of 6% Hydroxyethyl Starch 130/0.4 in Patients Undergoing Major Elective Surgery: An Uncontrolled, Open-Labeled, Multi-Center Study

Respiratory consequences of perioperative complications related to anaesthesia

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