Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?

Brandstrup, Birgitte; Svendsen, Pia; Rasmussen, Morten; Belhage, Bo; Rodt, S. Å.; Hansen, Bjarke Brandt; Møller, Dorthe Ritz; Lundbech, Liselotte B; Andersen, Noémi Becser; Berg, Victor J. van den; Thomassen, Niels; Andersen, Stig Kjær; Simonsen, Lene

doi:10.1093/bja/aes163

Cited by 252 publications

(188 citation statements)

References 33 publications

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“…22 Again, the total fluid needed was low (1,491 mL in the zero-balance group vs 1,876 mL in the GDFT group). In addition, when this volume of fluid is needed in an established ERAS program, it is unsurprising that GDFT does not achieve any benefits.…”

Section: Goal-directed Fluid Therapy Within An Eras Protocolmentioning

confidence: 92%

“…A better term to describe low crystalloid therapy regimes is zero-balance fluid therapy -with the aim of maintaining central euvolemia while minimizing excess salt and water. 22 For many patients, minimizing excess fluid with a zerobalance approach will be sufficient for their clinical needs (see section on matching monitoring needs to patient and surgical risk). Nevertheless, in more major surgery with greater blood loss and more complex fluid shifts, boluses of fluid may be required to maintain euvolemia.…”

Section: Maintenance Fluid Therapymentioning

confidence: 99%

“…Finally, and extremely importantly, in both the Srinivasa and Brandstrup studies, GDFT was not associated with harm when compared with a zero-balance strategy. 14,22 Matching monitoring needs to patient and surgical risk What conclusions can we draw from these recent studies of GDFT within an ERAS protocol? Undoubtedly, ERAS protocols have made intraoperative fluid management easier.…”

Section: Goal-directed Fluid Therapy Within An Eras Protocolmentioning

confidence: 99%

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Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

149

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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Section: Goal-directed Fluid Therapy Within An Eras Protocolmentioning

confidence: 92%

Section: Maintenance Fluid Therapymentioning

confidence: 99%

Section: Goal-directed Fluid Therapy Within An Eras Protocolmentioning

confidence: 99%

See 1 more Smart Citation

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

149

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“…The experienced anaesthesiologist can keep the patient in this zone of normovolaemia throughout the operative and immediate post‐operative periods. The use of additional monitoring devices such as pulse pressure variation (PPV), stroke volume variation (SVV), oesophageal Doppler and pulse contour wave analysis can all provide the anaesthesiologist with additional useful information to help guide fluid therapy, even though routine use of advanced hemodynamic monitoring and cardiac output optimisation has not shown to consistently improve post‐operative outcomes 70, 71, 72, 73. This is more important when the physiological situation is challenging such as haemorrhage, poor cardiac function or vasodilatation secondary to drugs, regional analgesia or sepsis.…”

Section: Surgery and Fluid Balancementioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

339

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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“…It would be premature to make practice changes based on this single study, but it is thought provoking and additional work is needed in this area. 127 Evidence is accumulating that decreasing tidal volumes used for intraoperative mechanical ventilation leads to improved outcomes. 128,129 Many measures of fluid responsiveness were validated using 8-10 mLÁkg -1 tidal volumes, and because they are dependent on intrathoracic pressure changes, they may not be as useful as tidal volumes in contemporary practice which have generally decreased to the 5-6 mLÁkg -1 range.…”

Section: Future Directionsmentioning

confidence: 99%

Inter-device differences in monitoring for goal-directed fluid therapy

Thiele

Bartels

Gan

2014

Can J Anesth/J Can Anesth

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Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?

Abstract: Goal-directed fluid therapy to near-maximal SV guided by ED adds no extra value to the fluid therapy using zero balance and normal BW in patients undergoing elective colorectal surgery.

Cited by 252 publications

References 33 publications

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Inter-device differences in monitoring for goal-directed fluid therapy

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