Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures

Bampoe, Sohail; Odor, Peter M.; Dushianthan, Ahilanandan; Bennett‐Guerrero, Elliott; Cro, Suzie; Gan, Tong J.; Grocott, Michael P.W.; James, Michael F.; Mythen, Michael G.; O’Malley, Catherine; Roche, Anthony; Rowan, Kathy; Burdett, Edward

doi:10.1002/14651858.cd004089.pub3

Cited by 42 publications

(29 citation statements)

References 68 publications

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“…Our results are consistent with the findings of a recent Cochrane review of 18 small randomized trials with a total of 1,096 surgical patients (about an eighth the number in our trial) concluding that fluid types did not differentially affect mortality or organ function. 18 Our results are at odds with a large registry analysis of patients who had noncardiac surgery concluding that postoperative morbidity is worse with saline than with a balanced solution. 19 Presumably the randomized trial conclusions that indicate comparable results with each fluid constitute the more reliable evidence.…”

Section: Discussionmentioning

confidence: 54%

Saline versus Lactated Ringer’s Solution

et al. 2020

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Background: Both saline and lactated Ringer's solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer's solution than normal saline. Methods:The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer's solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury.results: Among 8,616 qualifying patients, 4,187 (49%) were assigned to lactated Ringer's solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer's versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I-III versus 0, occurred in 6.6% of lactated Ringer's patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful.conclusions: In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer's or saline volume replacement. Clinicians can reasonably use either solution intraoperatively. (ANESTHESIOLOGY 2020; 132:614-24) What We Already Know about This Topic • Infusion of large volumes of saline causes hyperchloremic metabolic acidosis • A recent Cochrane review based on 18 small trials reported that major morbidity and mortality were comparable with perioperative saline or lactated Ringer's use What This Article Tells Us That is New• In a large single-center alternating cohort trial of patients having elective colorectal or orthopedic surgery, there was no clinically meaningful difference in the risk of a composite of in-hospital mortality and major postoperative complications including renal, respiratory, infectious, and hemorrhagic complications A bout 51 million inpatient surgeries were performed in the United States in 2010, based on National Hospital Discharge Survey. 1 Nearly all surgeries require intravenous crystalloid fluids for drug administration and vascular volume repletion. Saline (0.9% sodium chloride; "normal saline") is a commonly used crystalloid, but it has a much higher chloride concentration than human plasma, and is thus u...

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Section: Discussionmentioning

confidence: 54%

Saline versus Lactated Ringer’s Solution

et al. 2020

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“…Excess chloride has been associated with increased renal vasoconstriction, decreased urine output and increased mortality and length of stay after noncardiac surgery (Reid et al 2003; Wilkes et al 2001;McCluskey et al 2013). However, in meta-analysis, when comparing the use of balanced versus non-balanced intravenous solutions in the perioperative period, although the incidence of hyperchloremia was signi cantly higher in those receiving unbalanced solutions, no difference was found in mortality or major morbidity (Bampoe et al 2017). Although the consequences of hyperchloremia may be subtle, it seems reasonable to avoid any iatrogenic hemostatic imbalance by reducing the use of 0.9% NaCl solution.…”

Section: Discussionmentioning

confidence: 99%

The hidden secrets of a neutral pH – Blood-Gas-Analysis of postoperative patients according to the Stewart approach

Janssen

Fessem

Ris

et al. 2020

Preprint

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Background The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach. Methods We conducted a single center retrospective observational cohort study. Over a 17 month period, data on arterial blood gas analysis, electrolytes and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe) and strong ion gap (SIG) were calculated. Results Out of 1207 HDU admissions, 400 cases had a complete set of laboratory-data including albumin of which 281 presented with neutral pH (7.35 ≤ pH ≤ 7.45), 64 with acidemia (pH < 7.35) and 55 with alkalemia (pH > 7.45). In pH neutral patients the following acidifying disturbances were found: SIDa was lowered in 101 (36%), SIG was raised in 60 (21%). Base excess (BE) was decreased in 16 (6%) and corrected AG raised in 107 (38%). The alkalizing effect of hypoalbuminemia was present in 137 (49%). Out of 134 cases with normal BE and corrected AG, SIDa was lowered in 58 (43%). Out of 136 cases with normal SIDa and SIG, none had lowered BE and 28 increased AG (21%). Length of stay was significantly longer in patients with hypoalbuminemia, lowered SIDa and increased corrected AG, but not decreased BE (Hypoalbuminemia: 16 days vs. 10 days, P < 0.001. Low SIDa: 15 days vs. 12 days, P = 0.015. Increased AG: 16 days vs. 11 days, P < 0.001. Low BE: 14 days vs. 13 days, P = 0.736). Conclusions Metabolic disturbances, characterized mainly by the presence of lowered SIDa, increased AG and hypoalbuminemia, are frequent in our population with apparent neutral acid-base balance based on pH and base excess. These changes on the morning after surgery are associated with increased length of stay.

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“…Обсервационные исследования показали, что внутривенное введение нормального физиологического раствора может быть связано с повышенным риском хирургических осложнений, острым повреждением почек и смертью по сравнению с введением кристаллоидов с более низкими концентрациями хлоридов [33]. [34][35][36].…”

Section: физиологический растворunclassified

Клиническая Физиология И Клиническая Фармакология Современной Инфузионной Терапии Циркуляторного Шока (Обзор Литературы)

Yovenko¹,

Tsarev²,

Kužmová³

et al. 2021

ЕМ

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В обзоре литературы представлены современные взгляды в отношении инфузионной терапии циркуляторного шока. Описаны физиологическая четырехфазная модель шока и пересмотренное уравнение Старлинга. Приведено обоснование выбора инфузионных сред, их дозировки и длительности введения. Интенсивная терапия у пациентов с шоком предполагает четыре фазы инфузионной терапии: 1) жидкостной реанимации; 2) оптимизации волемического статуса; 3) стабилизации волемического статуса; 4) эвакуации избытка жидкости. Во время данной терапии необходимо ответить на четыре вопроса: 1) когда начинать внутривенную инфузию жидкости? 2) когда прекратить внутривенную инфузию жидкости? 3) когда начинать деэскалацию инфузионной терапии или активное удаление жидкости? 4) когда прекратить деэскалацию инфузионной терапии? Для оценки и мониторинга эффективности инфузионной терапии возможно использование статических и динамических маркеров сердечной преднагрузки. В отношении ряда препаратов для внутривенного введения получены данные современных высококачественных исследований, которые показывают опасные побочные эффекты данных препаратов и предполагают отказ или существенное ограничение их дальнейшего использования. Перегрузка жидкостью и отек тканей во время интенсивной терапии неотложных состояний могут наносить существенный вред пациентам. Эти данные являются вес-ким аргументом в пользу рестриктивной стратегии инфузионной терапии, которая может улучшить исходы лечения критических больных. Назначение инфузионной терапии у пациентов с шоком требует учитывать состав, фармакодинамические и фармакокинетические свойства инфузионных сред. В клинической практике необходимо рассмотреть «четыре D» жидкостной терапии: drug, dosing, duration, deescalation — препарат, доза, продолжительность введения и деэскалация.

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Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures

Cited by 42 publications

References 68 publications

Saline versus Lactated Ringer’s Solution

Saline versus Lactated Ringer’s Solution

The hidden secrets of a neutral pH – Blood-Gas-Analysis of postoperative patients according to the Stewart approach

Клиническая Физиология И Клиническая Фармакология Современной Инфузионной Терапии Циркуляторного Шока (Обзор Литературы)

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