Observational study on fluid therapy management in surgical adult patients

Abstract

Background Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country. Methods We designed the Fluid Day study as a cross-sectional, multicentre, observational study. The study was performed in 131 Spanish hospitals in February 2019. We included adult patients undergoing general anaesthesia for either elective or non-elective surgery. Demographic variables were recorded, as well as the type and total volume of fluid administered during the perioperative period and the monitorization used. To perform the analysis, patients were categorized by risk group. Results We recruited 7291 patients, 6314 of which were included in the analysis; 1541 (24.4%) patients underwent high-risk surgery, 1497 (23. 7%) were high risk patients, and 554 (8.7%) were high-risk patients and underwent high-risk surgery; 98% patients received crystalloids (80% balanced solutions); intraoperative colloids were used in 466 patients (7.51%). The hourly intraoperative volume in mL/kg/h and the median [Q1; Q3] administered volume (mL/kg) were, respectively, 6.67 [3.83; 8.17] ml/Kg/h and 13.9 [9.52;5.20] ml/Kg in low-risk patients undergoing low- or intermediate-risk surgery, 6 [4.04; 9.08] ml/Kg/h and 15.7 [10.4;24.5] ml/Kg in high- risk patients undergoing low or intermediate-risk surgery, 6.41 [4.36; 9.33] ml/Kg/h and 20.2 [13.3;32.4] ml/Kg in low-risk patients undergoing high-risk surgery, and 5.46 [3.83; 8.17] ml/Kg/h and 22.7[14.1;40.9] ml/Kg in high-risk patients undergoing high- risk surgery . We used advanced fluid monitoring strategies in 5% of patients in the intraoperative period and in 10% in the postoperative period. Conclusions The most widely used fluid was balanced crystalloids. Colloids were used in a small number of patients. Hourly surgery volume tended to be more restrictive in high-risk patients but confirms a high degree of variation in the perioperatively administered volume. Scarce monitorization was observed in fluid therapy management. Trial registration Clinical Trials: NCT03630744.

Multidisciplinary expert panel report on fluid stewardship: perspectives and practice

“…Nevertheless, most of the available literature continues to focus on resuscitation fluids. Studies now confirm the benefits of avoiding excessive 0.9% NaCl administration, including reduced risk of mortality or major complications such as myocardial infarction, in favor of balanced crystalloids, with a consensus that this is especially true in patients with sepsis, burns and diabetic keto-acidosis, but not for those with traumatic brain injury where saline should still be preferred [ 38 ]. Although the magnitude of benefit may be small in controlled studies, in the ‘real world’ volumes of fluid are not precisely controlled and many excess liters of fluid may be given.…”

“…One cross-sectional, multicenter, observational study of fluid management in more than 7000 patients reported a high degree of variability in perioperative volume delivered. Moreover, advanced fluids monitoring strategies were only used in 5% and 10% of patients in the intraoperative and postoperative periods, respectively [ 38 ]. Improving basic fluid administration on medical and surgical wards is achievable with better education and standardization of use.…”

Comparison of Effects of Sugammadex and Neostigmine on Postoperative Neuromuscular Blockade Recovery in Patients with Interstitial Lung Diseases Undergoing Transbronchial Cryobiopsy: A Randomized Trial

“…A larger sample size may have yielded more conclusive clinical results. Second, our study focused only on the management of realistic conditions, and did not consider other factors that can contribute to PPCs, such as opioid dosage and fluid therapy [ 22 ]. Therefore, further well-designed, large-scale prospective studies are needed to gain a comprehensive understanding of PPCs following procedures.…”

Predictive study of pharmacological reversal for residual neuromuscular blockade and postoperative pulmonary complications: a prospective, observational, cohort study

“…Moreover, our results were based on clinical management under real-life conditions. We have not analyzed other factors, such as mechanical ventilation parameters, recruitment maneuvers, opioid doses, fluid therapy, and others that are known to increase these complications and probably need to be assessed in subsequent studies 39 , 40 .…”