Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery

Yates, David R.; Davies, Simon; Milner, H.E.; Wilson, Rebekah

doi:10.1093/bja/aet307

Cited by 155 publications

(174 citation statements)

References 30 publications

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“…They found no difference in outcomes although, similar to a previous study, 60% more fluid was needed in the crystalloid group [73]. Therefore, in clinical practice without significant hypovolemia, the colloid-to-crystalloid ratio appears to be approximately 1:1.5 [72,73]. However, the volume effect of colloids is context sensitive [14], and when hypovolemia is present, the colloid-to-crystalloid ratio may be higher [71].…”

Section: Recent Studies Of Gdft Within An Enhanced Recovery Programsupporting

confidence: 61%

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State-of-the-art fluid management in the operating room

Miller

Raghunathan

Gan

2014

Best Practice & Research Clinical Anaesthesiology

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The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.

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Section: Recent Studies Of Gdft Within An Enhanced Recovery Programsupporting

confidence: 61%

“…Yates et al recently conducted an RCT comparing the use of boluses of crystalloid or colloid for GDFT during major surgery [72]. They found no difference in outcomes although, similar to a previous study, 60% more fluid was needed in the crystalloid group [73].…”

Section: Recent Studies Of Gdft Within An Enhanced Recovery Programmentioning

confidence: 65%

State-of-the-art fluid management in the operating room

Miller

Raghunathan

Gan

2014

Best Practice & Research Clinical Anaesthesiology

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“…A recent study comparing crystalloids with colloids for fluid boluses within a GDFT algorithm found no difference in the primary outcome of postoperative GI morbidity at postoperative day five. 64 Nevertheless, there was a significantly higher 24-hr positive fluid balance in the crystalloid group, and 38% of patients in this group required a rescue colloid bolus (median volume 750 mL). There was also minimal blood loss in both groups, which is the setting in which a colloid may be most beneficial.…”

Section: Which Fluid Should I Use?mentioning

confidence: 85%

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

230

137

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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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“…Although in a different patient population, this has prompted further investigation of the issue of crystalloid versus colloid in perioperative GDT. Studies comparing crystalloid-versus colloid-based GDT in both colorectal 82 and neurosurgical 83 procedures have demonstrated lower IV fluid volumes in colloid-based GDT patients without any meaningful clinical differences between the 2 groups. A study comparing balanced crystalloid-versus colloid-based GDT algorithms in patients undergoing cytoreductive surgery for primary ovarian cancer demonstrated lower volumes of intravenous fluids, higher CO, and higher SV in colloid patients, though they found no differences in postoperative complications of LOS.…”

Section: Fluidsmentioning

confidence: 99%