Fluid management for critical patients undergoing urgent colectomy

Grass, Fabian; Pache, Basile; Butti, Fabio; Solà, Josep; Hahnloser, Dieter; Demartines, Nicolas

doi:10.1111/jep.13207

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…The thresholds are displayed with their respective impact on specific outcomes or clinical consequences. Three papers from the Lausanne group tried to identify thresholds through receiver operating characteristics (ROC) curves in different surgical settings: minimally invasive surgery [50], open surgery [73], and lastly, surgery for urgent indications [72]. Interestingly, the thresholds did not differ significantly across the different settings.…”

Section: Summary Of Institutional Thresholds and Practice Guidancementioning

confidence: 99%

Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice

Deslarzes,

Jurt,

Larson

et al. 2024

JCM

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The present review discusses restrictive perioperative fluid protocols within enhanced recovery after surgery (ERAS) pathways. Standardized definitions of a restrictive or liberal fluid regimen are lacking since they depend on conflicting evidence, institutional protocols, and personal preferences. Challenges related to restrictive fluid protocols are related to proper patient selection within standardized ERAS protocols. On the other hand, invasive goal-directed fluid therapy (GDFT) is reserved for more challenging disease presentations and polymorbid and frail patients. While the perfusion rate (mL/kg/h) appears less predictive for postoperative outcomes, the authors identified critical thresholds related to total intravenous fluids and weight gain. These thresholds are discussed within the available evidence. The authors aim to introduce their institutional approach to standardized practice.

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Section: Summary Of Institutional Thresholds and Practice Guidancementioning

confidence: 99%

Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice

Deslarzes,

Jurt,

Larson

et al. 2024

JCM

Self Cite

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“…As such, detailed descriptive data on the prevalence and clinical impact of electrolyte disturbances in patients undergoing emergency high‐risk abdominal surgery are lacking [11]. This study aimed to assess the prevalence of electrolyte and acid–base disturbances and the associations with postoperative outcome in patients undergoing emergency high‐risk abdominal surgery, treated within a standardized pathway, specifically focusing on potential differences in patients with IO versus PV.…”

Section: Introductionmentioning

confidence: 99%

Electrolyte and Acid–Base Disturbances in Emergency High‐Risk Abdominal Surgery, a Retrospective Study

et al. 2022

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BACKGROUNDPatients undergoing emergency high-risk abdominal surgery potentially suffer from both systemic dehydration and hypovolaemia. Data on the prevalence and clinical impact of electrolyte disturbances in this patient group, speci cally the potential differences in patients with intestinal obstruction (IO) versus perforated viscus (PV) is lacking. METHODSIn this retrospective single center cohort study, adult patients undergoing emergency high-risk abdominal surgery in a standardized perioperative pathway were included. Electrolyte and arterial blood gas analysis were measured prior to and just after surgery. Prevalence and clinical impact of electrolyte disturbances were assessed. RESULTSA total of 354 patients were included in the study. Acid-base and electrolyte disturbances had a high incidence in both groups with preoperative alkalemia dominating preoperatively, signi cantly more prevalent in IO (45 vs.32%, p<.001), and acidosis being most pronounced postoperatively in PV (49 vs. 28%, p<.0001). Preoperative hypochloraemia and hypokalemia were more prevalent in the IO group (34 vs 20 % and 37 vs 25 % respectively).Hyponatremia was highly prevalent in both IO and PV.Of the electrolyte and acid-base disturbances pre-and postoperative hypochloremia were the only ones independently associated with day-30 postoperative major complications and/or death in patients with IO, OR 2.87 (1.35, 6.23) p= 0.006 and OR 6.86 (1.71, 32.2) p= 0.009 respectively. Hypochloremic patients presented with reduced long-term survival as compared with the normo-and hyperchloremic patients, with postoperative hypochloremia having the most pronounced association (p<0.05).Neither plasma sodium nor potassium showed association with outcome. CONCLUSIONThese observations suggest that both acute high risk abdominal patient have frequent preoperative alkalosis shifting to postoperative acidosis, and that both pre-and postoperative hypochloremia are independently associated with both impaired short-and long-term outcome in patients with intestinal obstruction, which potential implications for the choice of resuscitations uids. Research on pathophysiology and treatment strategies for electrolyte disturbances are needed in patients undergoing emergency high-risk abdominal surgery. BackgroundIntravenous uid therapy is one of the most frequent interventions in critically ill patients(1). All high-risk surgical patients are given intravenous uid therapy(2) and abnormalities in acid-based homeostasis and electrolytes are common but insu ciently described.Patients undergoing emergency high-risk abdominal surgery due to e.g. intestinal obstruction (IO) or perforated viscus (PV) potentially suffer from systemic dehydration due to inadequate uid intake, vomiting ,pathological

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Challenges in optimising recovery after emergency laparotomy

Foss

Kehlet

2020

Anaesthesia

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SummaryStandardised peri‐operative care pathways for patients undergoing emergency laparotomy or laparoscopy for non‐traumatic pathologies have been shown to be inadequate and associated with high morbidity and mortality. Recent research has highlighted this problem and showed that simple pathways with ‘rescue’ interventions have been associated with reduced mortality when implemented successfully. These rescue pathways have focused on early diagnosis and surgery, specialist surgeon and anaesthetist involvement, goal‐directed therapy and intensive or intermediary postoperative care for high‐risk patients. In elective surgery, enhanced recovery has resulted in reduced length of stay and morbidity by the application of procedure‐specific, evidence‐based interventions inside rigorously implemented patient pathways based on multidisciplinary co‐operation. The focus has been on attenuation of peri‐operative stress and pain management to facilitate early recovery. Patients undergoing emergency laparotomy are a heterogeneous group consisting mostly of patients with intestinal perforations and/or obstruction with varying levels of comorbidity and frailty. However, present knowledge of the different pathophysiology and peri‐operative trajectory of complications in these patient groups is limited. In order to move beyond rescue pathways and to establish enhanced recovery for emergency laparotomy, it is essential that research on both the peri‐operative pathophysiology of the different main patient groups – intestinal obstruction and perforation – and the potentially differentiated impact of interventions is carried out. Procedure‐ and pathology‐specific knowledge is lacking on key elements of peri‐operative care, such as: multimodal analgesia; haemodynamic optimisation and fluid management; attenuation of surgical stress; nutritional optimisation; facilitation of mobilisation; and the optimal use and organisation of specialised wards and improved interdisciplinary collaboration. As such, the future challenges in improving peri‐operative patient care in emergency laparotomy are moving from simple rescue pathways to establish research that can form a basis for morbidity‐ and procedure‐specific enhanced recovery protocols as seen in elective surgery.

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Fluid management for critical patients undergoing urgent colectomy

Cited by 4 publications

References 30 publications

Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice

Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice

Electrolyte and Acid–Base Disturbances in Emergency High‐Risk Abdominal Surgery, a Retrospective Study

Challenges in optimising recovery after emergency laparotomy

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