Comparison of liberal and goal‐directed fluid therapy after small intestinal surgery for strangulating lesions in horses

Abstract

Background: There are few guidelines for the appropriate mode of fluid administration during and after colic surgery, and is challenging to reach the right balance while avoiding overhydration. This study aimed to compare goal-directed fluid therapy (GDFT) and 'liberal' fluid regimens (LFRs) in horses undergoing small intestinal surgery. Methods: Eighteen horses subjected to small intestinal surgery were matched according to the surgical lesion, type of anastomosis, length of resection, and duration of clinical signs. Horses in the LFR group were administered intravenous (IV) fluids for at least 24 h. In the GDFT group, IV fluids were administered only when considered necessary based on clinical parameters. Postoperative reflux (POR), packed cell volume, total protein, heart rate, venous lactate level, complications, and long-term survival rates were compared. Results: Three horses in the LFR and one in the GDFT group developed POR. Horses in the GDFT group had a shorter time interval to first oral water intake and shorter hospitalisation time. Postoperative complication rates and survival were not different between groups. Conclusion: Further studies are necessary to set guidelines for the evaluation of hydration status and to plan postoperative fluid administration; however, GDFT may be a valid alternative to liberal fluid therapy after colic surgery.

Short-Term Survival and Postoperative Complications Rates in Horses Undergoing Colic Surgery: A Multicentre Study

“…Post-operative treatments are often expensive, and it is essential to reduce the cost of colic surgery through a more selective approach to drug use and a greater emphasis on preventing complications [ 2 , 43 ]. A study by Giusto and colleagues showed that “goal directed” fluid administration is not associated with higher postoperative complications than standard rates of administration, and it has the advantage of being less expensive and reducing hospitalization time [ 44 ]. Crystalloid administration influenced the outcome in this study and although there are no studies showing the effect of overhydration on the outcome in horses, the results of our study confirm the need to use a goal directed fluid therapy.…”

Highlights of recent clinically relevant papers

“…This study by Gessica Giusto and co‐workers in Italy compared goal‐directed fluid therapy (GDFT) and 'liberal' fluid regimens (LFRs) in horses undergoing small intestinal surgery .…”

Fluid therapy in horses: how much is too much?

“…25 Such fluids in low volumes could replace water needs in less critical postoperative colic cases more effectively than replacement fluids that are too high in sodium. 20,22,24 In Giusto and colleagues' study, 1 horses were assigned to undergo either liberal (LFR) or goaldirected (GDFT) approaches to fluid therapy. For at least 24 hours after surgery, the LFR group received intravenous fluids at 2 ml/kg/h (ie, Fluid therapy for horses is usually delivered by intravenous infusion from 5 litre bags.…”

“…In Giusto and colleagues’ study, 1 horses were assigned to undergo either liberal (LFR) or goal‐directed (GDFT) approaches to fluid therapy. For at least 24 hours after surgery, the LFR group received intravenous fluids at 2 ml/kg/h (ie, 80 per cent of the maintenance rate for a fed horse), combined with sufficient additional fluids to offset losses.…”

“…In a paper summarised on p 106 of this issue of Vet Record, Giusto and colleagues examined responses to two different strategies for fluid therapy in horses that underwent surgery for a strangulated small intestine. 1 The importance of fluid therapy in these horses is beyond doubt, and these are the types of cases that display the most favourable response to this treatment. So, why would a comparison between the response to a lower rate of fluid infusion and the response to a more traditional approach to fluid therapy warrant investigation?…”