Crystalloids versus colloids for goal-directed fluid therapy in major surgery

Abstract

Introduction Perioperative hypovolemia arises frequently and contributes to intestinal hypoperfusion and subsequent postoperative complications. Goal-directed fluid therapy might reduce these complications. The aim of this study was to compare the effects of goal-directed administration of crystalloids and colloids on the distribution of systemic, hepatosplanchnic, and microcirculatory (small intestine) blood flow after major abdominal surgery in a clinically relevant pig model.

Respiratory consequences of perioperative complications related to anaesthesia

“…Our results demonstrate no major benefit of this manoeuvre on either the airway or the lung tissue mechanics ( Figure 7). This finding agrees with previous results where no beneficial effect of a PEEP rise on the respiratory compliance was demonstrated following acid aspiration [28]. However, the lack of an increase in SIII in Group P10 indicates that the elevated PEEP prevented the development of ventilation defects in the lung periphery.…”

“…In agreement with the findings of the few previous studies in which the mechanical changes were assessed for both lungs together in various animal models, we observed an acute deterioration in the lung tissue mechanics in the aspirated lung [28,46,47]. This adverse change can be attributed to pulmonary oedema due to the increased vascular permeability [28,48,49], surfactant dysfunction [19,50] and inflammation [25,26].…”

“…This adverse change can be attributed to pulmonary oedema due to the increased vascular permeability [28,48,49], surfactant dysfunction [19,50] and inflammation [25,26]. Since all of these processes promote the development of atelectasis leading to a lung volume loss, the elevations in the unilateral G and H in the aspirated lungs are likely to occur subsequently to this Respiratory abnormalities were also assessed in the present study by measuring SIII and SnIII.…”

“…While an elevated PEEP is beneficial for the recruitment of lung regions and maintaining them open during mechanical ventilation [28,29], a significant hemodynamic impairment characterized by a deterioration in cardiac function may also occur during a PEEP increment [30].…”

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

“…According to the current concept, any deficit in circulating plasma should be replaced with a colloid, and this infusion of colloid should be guided by goal-directed methods (Chappell et al 2008, Hiltebrand et al 2009). …”