Variation in crystalloid administration: an analysis of 6248 patients undergoing major elective surgery

Kim, Yuhree; Gani, Faiz; Spolverato, Gaya; Ejaz, Aslam; Xu, Li; Buettner, Stefan; Wagner, Doris; Wasey, Jack O.; Frank, Steven M.; Pawlik, Timothy M.

doi:10.1016/j.jss.2016.02.045

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Therefore, variability in fluid volume may simply reflect the ability of clinicians to adapt fluid administration to individual patient needs. In 6248 patients undergoing high risk surgery, Kim and colleagues 57 recently showed that over 90% of the variability in crystalloid administration can be attributed to patient factors whereas only 10% was due to factors at the level of the care provider. One may then hypothesize that GDT helps clinicians to give the right amount of fluid to the right patients at the right time, without necessarily modifying the average amount of fluid given to a patient population (Fig.…”

Section: Discussionmentioning

confidence: 99%

Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Michard

Giglio

Brienza

2017

British Journal of Anaesthesia

199

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Previous meta-analyses suggest that perioperative goal-directed therapy (GDT) is useful to decrease postoperative morbidity. Most GDT studies analysed were done with pulmonary artery catheters, oesophageal Doppler and calibrated pulse contour methods. Uncalibrated pulse contour (uPC) techniques are an appealing alternative but their accuracy has been questioned. The effects of GDT on fluid management (volumes and volume variability) remain unclear. We performed a meta-analysis of randomized controlled trials investigating the effects of GDT with uPC methods on postoperative outcome. The primary endpoint was postoperative morbidity. Fluid volumes and fluid volume variability (standard deviation/mean) over the GDT period were also studied. Nineteen studies met the inclusion criteria (2159 patients). Postoperative morbidity was reduced with GDT (OR 0.46, 95% CI 0.30-0.70, P<0.001). The volume of colloids was higher [weighted mean difference (WMD) +345 ml, 95% CI 148-541 ml, P<0.001] and the volume of crystalloids was lower (WMD -429 ml, 95% CI -634 to -224 ml, P<0.01) in the GDT group than in the control group. However, the total volume of fluid (WMD -220 ml, 95% CI -590 to 150 ml, P=0.25) and the variability of fluid volume (34% vs 33%, P=0.98) were not affected by GDT. The use of GDT with uPC techniques was associated with a decrease in postoperative morbidity. It was not associated with an increase in total fluid volume nor with a decrease in fluid volume variability.

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Section: Discussionmentioning

confidence: 99%

Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Michard

Giglio

Brienza

2017

British Journal of Anaesthesia

199

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“…Additional FT was provided as Lactated Ringer's (LR) solution; hypotensive anesthesia (HA) allowed significant reduction of amount of LR infused compared to normotensive anesthesia (NA). The applied policy allowed sparing of the recently [15][16][17] reported variability of response to crystalloid FT alone during major abdominal surgeries.…”

Section: Resultsmentioning

confidence: 99%

Esmolol hypotension maintains tissue perfusion during myomectomy judged by Masimo monitoring of regional cerebral oxygen saturation and pleth variability index

Salman

Shehab

2018

Egyptian Journal of Anaesthesia

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To evaluate outcome of elective abdominal myomectomy under esmolol hypotensive anesthesia (HA) compared to normotensive anesthesia (NA). Methods: Patients were randomly divided into NA Group received NA and HA Group received esmolol (0.5 mg/ kg) bolus then infusion (0.05-0.3 mg/kg/min) to maintain mean arterial pressure at 60-70 mmHg till completion of myomectomy. Masimo Radical 7 was used to monitor regional cerebral oxygenation (rSO 2), total hemoglobin (Hb.) and pleth variability index (PVI). Fluid therapy (FT) included initial bolus of 5% human plasma protein followed by intraoperative (IO) Lactated Ringer's (LR) solution. Amount of IO blood loss, blood transfusion and urine output (UOP) were determined. Postoperative (PO) Hb. conc. was measured at laboratory (Lab). Results: IO blood pressure was significantly lower, while PVI was significantly higher with significantly lower ΔPVI with HA than NA. Operative time was significantly shorter with significantly less IO blood loss and blood transfusion with HA. Regional cerebral and peripheral tissue oxygen saturations showed non-significant difference between both groups. PO Masimo measured and Lab estimated Hb. was significantly higher with significantly lower ΔHb% in HA than NA group. Masimo measurement was significantly higher with significantly lower ΔHb% than lab estimation in both groups. Patients of NA group received significantly greater amount of LR, but UOP was non-significantly higher than in HA group. Conclusion: Esmolol HA allowed better control of IO bleeding, blood transfusion and FT. Masimo continuous monitoring of rSO2 assured preserved cerebral perfusion. Masimo measured PVI could non-invasively monitor tissue perfusion. 3. Setting Tertiary referral hospital, KSA.

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“…For instance, at the John Hopkins Hospitals, over a 4-year period, the median crystalloid volume that was infused during lung surgery was 11.3 mL/kg/h with large variations between anesthesiologists. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Restricted, optimized or liberal fluid strategy in thoracic surgery

Licker

Hagerman

Bédat

et al. 2021

Saudi Journal of Anaesthesia

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Perioperative fluid balance has a major impact on clinical and functional outcome, regardless of the type of interventions. In thoracic surgery, patients are more vulnerable to intravenous fluid overload and to develop acute respiratory distress syndrome and other complications. New insight has been gained on the mechanisms causing pulmonary complications and the role of the endothelial glycocalix layer to control fluid transfer from the intravascular to the interstitial spaces and to promote tissue blood flow. With the implementation of standardized processes of care, the preoperative fasting period has become shorter, surgical approaches are less invasive and patients are allowed to resume oral intake shortly after surgery. Intraoperatively, body fluid homeostasis and adequate tissue oxygen delivery can be achieved using a normovolemic therapy targeting a “near-zero fluid balance” or a goal-directed hemodynamic therapy to maximize stroke volume and oxygen delivery according to the Franck–Starling relationship. In both fluid strategies, the use of cardiovascular drugs is advocated to counteract the anesthetic-induced vasorelaxation and maintain arterial pressure whereas fluid intake is limited to avoid cumulative fluid balance exceeding 1 liter and body weight gain (~1-1.5 kg). Modern hemodynamic monitors provide valuable physiological parameters to assess patient volume responsiveness and circulatory flow while guiding fluid administration and cardiovascular drug therapy. Given the lack of randomized clinical trials, controversial debate still surrounds the issues of the optimal fluid strategy and the type of fluids (crystalloids versus colloids). To avoid the risk of lung hydrostatic or inflammatory edema and to enhance the postoperative recovery process, fluid administration should be prescribed as any drug, adapted to the patient's requirement and the context of thoracic intervention.

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Variation in crystalloid administration: an analysis of 6248 patients undergoing major elective surgery

Cited by 9 publications

References 20 publications

Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Esmolol hypotension maintains tissue perfusion during myomectomy judged by Masimo monitoring of regional cerebral oxygen saturation and pleth variability index

Restricted, optimized or liberal fluid strategy in thoracic surgery

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