Contemporary Approaches to Perioperative IV Fluid Therapy

Myles, Paul S.; Andrews, Sam; Nicholson, Jonathan J; Lobo, Dileep N.; Mythen, Monty

doi:10.1007/s00268-017-4055-y

Cited by 65 publications

(46 citation statements)

References 66 publications

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“…POD 0 fluids of 3.5 l, however, was not retained as an independent risk factor for overall complications. Even though stringent fluid management to prevent postoperative complications is a widely accepted concept in patients undergoing elective surgery, no thresholds are available for guidance [6,18]. A wide variability of intra-operative fluid administration was described in a single-centre analysis of a colorectal surgical case-mix before implementation of goal-directed fluid therapy [19].…”

Section: Discussionmentioning

confidence: 99%

Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

et al. 2018

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Aim The present study aimed to analyse fluid management and to define optimal fluid‐related thresholds for elective open colorectal surgery. Method A retrospective analysis was made of all consecutive elective open colorectal resections performed in our tertiary centre between May 2011 and May 2017. The main outcomes were postoperative complications [overall (I–V) and severe (IIIB–V) according to the Clavien classification], respiratory complications and postoperative ileus (POI). Critical thresholds regarding perioperative fluid management and postoperative weight gain were identified by using receiver operator characteristic (ROC) analysis. Independent risk factors for overall complications were identified by multivariable logistic regression analysis. Results Of 121 patients who had open operations, 84 (69%) had some complication and 26 (21%) had severe complications. Respiratory complications and POI occurred in 15 (12%) and 46 patients (38%), respectively. The thresholds for intravenous fluids were 3.5 l at postoperative day (POD) 0 [area under ROC curve (AUROC) 0.7 for any 0.69 for respiratory complications] and 3.5 kg weight gain at POD 2 (AUROC 0.82 for respiratory complications). Multivariable analysis revealed weight gain of > 3.5 kg at POD 2 (OR 5.9; 95% CI 1.3–16.6) as a significant risk factor for overall complications. Acute kidney injury was observed in five patients (4%), three (5%) in the group with > 3.5 l at POD 0 and two (3%) in the group with < 3.5 l at POD 0 (P = 0.64). Creatinine increase was transitory and all patients regained baseline levels before discharge. Conclusion A weight gain of > 3.5 kg at POD 2 has been identified as the critical threshold for overall and respiratory complications and prolonged length of stay after open elective colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

et al. 2018

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“…These three factors consequently cause signal transducer and activator of transcription 3 (STAT-3) and nuclear factor-jb (NFjb) activation and reduction of myosin light-chain phosphorylation of the intestinal SM, such that the contractile activity of the muscle is reduced [86,108]. Several studies have shown the potential benefit of restrictive regimes in post-operative recovery [104,105,110], with oral fluids being introduced as soon as possible following surgery [111]. Colloid administration has not been shown to increase the risk of POI in humans in a retrospective study, potentially due to avoidance of third space fluid loss or a reduction in any third space fluid loss associated with crystalloid administration [109].…”

Section: Pharmacological/therapeutic Influencesmentioning

confidence: 99%

“…Liberal is defined as greater than 2.75 L/day (1.9 ml/kg/h for a 60 kg human); zero balance between 1.75 and 2.75 L/day and restrictive as less than 1.75 L/day in the post-operative period [110]. Several studies have shown the potential benefit of restrictive regimes in post-operative recovery [104,105,110], with oral fluids being introduced as soon as possible following surgery [111]. As a result, there is currently a large clinical study being performed in humans to fully evaluate fluid regimes and post-operative recovery, with results due in 2018 [112].…”

Section: Pharmacological/therapeutic Influencesmentioning

confidence: 99%

An update on equine post‐operative ileus: Definitions, pathophysiology and management

Lisowski

Pirie

Blikslager

et al. 2018

Equine Veterinary Journal

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Post-operative ileus (POI) is a serious condition which any horse undergoing abdominal surgery is at risk of developing, leading to increased hospitalisation time and resulting costs. Advances in the understanding of the development of equine POI are mainly based on human and rodent literature, where manipulation-induced inflammation has been identified as a trigger, with activation of resident muscularis externa macrophages playing a crucial role in the pathophysiology. Despite many pharmacological trials in all species, there is no single completely successful treatment for POI, highlighting that the condition is multifactorial in cause and requires a multimodal approach to minimise its incidence.

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“…Decreased urine output is no longer considered harmful and should not be the primary guide to fluid management. After surgery, early weaning of intravenous fluids and transition to oral fluids complete this perioperative strategy, which has repeatedly been associated with decreased postoperative morbidity. Within an enhanced recovery concept, minimally invasive surgery adds further advantages via a synergistic beneficial effect.…”

Section: Introductionmentioning

confidence: 99%

Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery

et al. 2019

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Background Perioperative fluid overload is an important modifiable risk factor for adverse outcomes after colorectal surgery. This study aimed to define critical thresholds for perioperative fluid management and postoperative weight gain for patients undergoing elective laparoscopic colorectal surgery. Methods This was an analysis of consecutive elective laparoscopic colorectal resections at Lausanne University Hospital from May 2011 to May 2017. Main outcomes were overall, major (Clavien–Dindo grade IIIb or above) and respiratory complications, and postoperative ileus. Thresholds regarding perioperative fluid management and postoperative weight gain were identified through receiver operating characteristic (ROC) analysis and clinical judgement. Independent risk factors for all four outcomes were assessed by multinominal logistic regression. Results Overall and major complications occurred in 210 (36·2 per cent) and 46 (7·9 per cent) of 580 patients respectively. Twenty‐three patients (4·0 per cent) had respiratory complications and 98 (16·9 per cent) had postoperative ileus. Median length of hospital stay was 5 (i.q.r. 3–9) days. Based on respiratory complications, thresholds for perioperative intravenous fluid administration (postoperative day (POD) 0) were set pragmatically at 3000 ml for colonic (calculated threshold 3120 ml (area under ROC curve (AUROC) 0·63)) and 4000 ml for rectal (AUROC 0·79) procedures. Postoperative weight gain of 2·5 kg at POD 2 was predictive of respiratory complications. Multivariable analysis retained perioperative intravenous fluid administration over the above thresholds as an independent risk factor for overall (odds ratio (OR) 2·25, 95 per cent c.i. 1·23 to 4·11), major (OR 2·49, 1·17 to 5·31) and respiratory (OR 4·71, 1·42 to 15·58) complications. Weight gain above 2·5 kg at POD 2 was identified as a risk factor for respiratory complications (OR 3·58, 1·10 to 11·70) and ileus (OR 1·82, 1·02 to 3·52). Conclusion Perioperative intravenous fluid and weight thresholds were associated with postoperative adverse outcomes. These thresholds need independent validation.

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Contemporary Approaches to Perioperative IV Fluid Therapy

Abstract: There is good evidence supporting the avoidance of unnecessary fasting and the value of an individualized perioperative IV fluid regimen, with transition to oral fluids as soon as possible, to help patients recover from major surgery.

Cited by 65 publications

References 66 publications

Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery

An update on equine post‐operative ileus: Definitions, pathophysiology and management

Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery

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