Normal Saline Versus Lactated Ringer’s Solution for Intraoperative Fluid Management in Patients Undergoing Abdominal Aortic Aneurysm Repair: An Outcome Study

Waters, Jonathan H.; Gottlieb, Alexandru; Schoenwald, Peter K.; Popovich, Marc J.; Šprung, Juraj; Nelson, David R.

doi:10.1097/00000539-200110000-00004

Cited by 376 publications

(245 citation statements)

References 6 publications

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“…3,12 A clinical trial in patients undergoing aortic aneurysm repair showed that patients receiving NS required more platelets than those receiving LR. 13 Additionally, the use of NS may also lead to increased acidosis as compared with LR.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

Rowell

Fair

Barbosa

et al. 2016

Journal of Neurotrauma

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Lactated Ringer's (LR) and normal saline (NS) are both used for resuscitation of injured patients. NS has been associated with increased resuscitation volume, blood loss, acidosis, and coagulopathy compared with LR. We sought to determine if pre-hospital LR is associated with improved outcome compared with NS in patients with and without traumatic brain injury (TBI). We included patients receiving pre-hospital LR or NS from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients with TBI (Abbreviated Injury Scale [AIS] head ‡3) and without TBI (AIS head £2) were compared. Cox proportional hazards models including Injury Severity Score (ISS), AIS head, AIS extremity, age, fluids, intubation status, and hospital site were generated for prediction of mortality. Linear regression models were generated for prediction of red blood cell (RBC) and crystalloid requirement, and admission biochemical/ physiological parameters. Seven hundred ninety-one patients received either LR (n = 117) or NS (n = 674). Median ISS, AIS head, AIS extremity, and pre-hospital fluid volume were higher in TBI and non-TBI patients receiving LR compared with NS ( p < 0.01). In patients with TBI (n = 308), LR was associated with higher adjusted mortality compared with NS (hazard rate [HR] = 1.78, confidence interval [CI] 1.04-3.04, p = 0.035). In patients without TBI (n = 483), no difference in mortality was demonstrated (HR = 1.49, CI 0.757-2.95, p = 0.247). Fluid type had no effect on admission biochemical or physiological parameters, 6-hour RBC, or crystalloid requirement in either group. LR was associated with increased mortality compared with NS in patients with TBI. These results underscore the need for a prospective randomized trial comparing pre-hospital LR with NS in patients with TBI.

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Section: Discussionmentioning

confidence: 99%

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

Rowell

Fair

Barbosa

et al. 2016

Journal of Neurotrauma

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“…[57][58][59][60][61][62] In particular, hyperchloremic acidosis has been shown to reduce gastric blood flow and decrease gastric intramucosal pH in elderly surgical patients. 58 It has also been shown to reduce renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers.…”

Section: Which Fluid Should I Use?mentioning

confidence: 99%

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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“…Üç lt.'den fazla "fizyolojik serum" infüzyonu 3 saatten fazla sürebilen "hiperkloremik metabolik asidoz"a neden olur [21,22] .…”

Section: İv Solüsyonlarunclassified

Fluid Therapy and Management

Aykaç¹,

Arslantaş²

2017

GKDA Derg

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Normal Saline Versus Lactated Ringer’s Solution for Intraoperative Fluid Management in Patients Undergoing Abdominal Aortic Aneurysm Repair: An Outcome Study

Abstract: Predominant use of 0.9% saline solution in major surgery has little impact on outcome as assessed by duration of mechanical ventilation, intensive care unit stay, hospital stay, and postoperative complications, but it does appear to be associated with increased perioperative blood loss.

Cited by 376 publications

References 6 publications

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Fluid Therapy and Management

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