State of the art in fluid and volume therapy

Rehm, Markus; Hulde, Nikolai; Kämmerer, T; Meidert, Agnes S.; Hofmann-Kiefer, Klaus

doi:10.1007/s00101-017-0290-8

Cited by 13 publications

(7 citation statements)

References 78 publications

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“…Interestingly, intraoperative infusion of colloidal solution > 1100 mL or intraoperative infusion of crystalloid solution > 2900 mL were identi ed as independent risk factors in the multivariate logistic regression analysis. Previous studies have shown that large amounts of colloid and can affect body coagulation functions [31][32][33], which was also con rmed in this study. Furthermore, we found that when the intraoperative input of colloidal uid was more than 1100 mL, the impact on postoperative coagulation was signi cant.…”

Section: Discussionsupporting

confidence: 88%

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

Cui

Shi

et al. 2021

Preprint

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Objective: To assess the association between immediate postoperative coagulopathy and the long-term survival of traumatic brain injury (TBI) patients undergoing surgery, as well as to explore predisposing risk factors of immediate postoperative coagulopathy.Methods: This retrospective study included 352 TBI patients from January 1, 2015, to April 25, 2019. The log-rank test and a Cox proportional hazard model were conducted to assess the relationship between immediate postoperative coagulopathy and the long-term survival of TBI patients. Furthermore, a multivariate logistic regression model was performed to identify the underlying risk factors for postoperative coagulopathy.Results: Of the 352 patients analyzed, the median age was 50 (41,60) years, and 82 (23%) patients were female. By May 26, 2019, 117 (33.24%) patients had died, 195 (55.40%) had survived, and 40 (11.36%) had been lost to follow-up. The median follow-up time was 773 days. In the log-rank test, immediate postoperative coagulopathy was significantly associated with the survival of TBI patients (P = 0.002). A Cox proportional hazard model identified immediate postoperative coagulopathy (HR, 1.471; 95% CI, 1.011-2.141; P = 0.044) as an independent risk factor for survival following TBI. According to multivariate logistic regression analysis, abnormal ALT and RBC at admission, intraoperative infusion of crystalloid solution > 2900 mL, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL were identified as independent risk factors for immediate postoperative coagulopathy.Conclusions: Those who suffered from immediate postoperative coagulopathy due to TBI were at higher risk of poor prognosis than those who did not.

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Section: Discussionsupporting

confidence: 88%

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

Cui

Shi

et al. 2021

Preprint

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“…[66,139]. Nicht zu unterschätzen ist der intraoperative Verlust onkotisch wirksamer Moleküle (insbesondere Proteine) aus dem Intravasalraum, welcher einerseits durch den chirurgischen Blutverlust selbst, andererseits aber auch durch eine Verschiebung in das Interstitium ("Protein-Shift") bedingt ist [116,117].…”

Section: Perioperative Fluid Management In Major Abdominal Surgeryunclassified

“…Auch die visuelle Einschätzung des in-traoperativen Blutverlustes ist potenziell fehlerbehaftet und wird in einer kürzlich veröffentlichten Studie von einem Großteil der befragten Anästhesisten als unzureichend empfunden [109]. Durch mathematische Betrachtung des mittleren Hämatokrits sowie des Erythrozytenvolumens -wie von Rehm et al beschrieben -besteht unter der Voraussetzung einer Normovolämie jedoch die Möglichkeit, denperioperativenBlutverlust zu berechnen [117].…”

Section: Intraoperative Phaseunclassified

“…So wurde gezeigt, dass abhängig von der Intaktheit der Gefäßbarriere und dem Flüssigkeits-/ Volumenstatus des Patienten teilweise bereits innerhalb der ersten Stunde nach Applikation lediglich 20 % des infundierten Volumens im Gefäßsystem verbleiben, während der Rest in das Interstitium diffundiert [50]. Sollen beispielsweise Blut-oder anderweitige Flüssigkeitsverluste ausgeglichen werden, wird häufig ein Ersatz des Blutverlustes im Verhältnis 3:1 mit Kristalloiden empfohlen [68,117]. Als Konsequenz kann eine "Überwässerung" mit Flüssigkeitsverschiebungen und den bereits erwähnten Nebenwirkungen resultieren.…”

Section: Eigenschaften Kristalloider Und Kolloidaler Lösungenunclassified

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Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

et al. 2020

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Zusammenfassung Die Gabe intravasaler Flüssigkeiten gehört zu den Grundpfeilern der perioperativen Therapie und nimmt insbesondere bei großen viszeralchirurgischen Eingriffen maßgeblichen Einfluss auf das chirurgische Behandlungsergebnis. Ein adäquates perioperatives Flüssigkeitsmanagement kann durch Vermeidung von Hypo- und Hypervolämie dazu beitragen, das Risiko einer unzureichenden Gewebeperfusion als Treiber postoperativer Morbidität und Letalität signifikant zu reduzieren. Der effektive Umgang mit intravasal zugeführten Flüssigkeiten setzt dabei die Kenntnis der Substanzen sowie Maßnahmen zur Therapiesteuerung voraus. Das Flüssigkeitsmanagement beginnt bereits präoperativ und sollte – unter Nutzung einer an die Bedürfnisse des Patienten angepassten und dem Eingriff entsprechenden hämodynamischen Überwachung – auch postoperativ im Aufwachraum und auf Station fortgesetzt werden. Der Kommunikation aller an der perioperativen Versorgung Beteiligten kommt im Sinne eines optimalen Flüssigkeitsmanagements eine entscheidende Bedeutung zu.

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“…Although the use of intravenous fluids is one of the most frequent interventions in the perioperative period of any surgical scenario, the choice between the different fluids, their dosage, management, and monitoring, remains controversial [ 4 – 6 ]. Fluids should be administered according to therapeutic targets, and they should be given at the right time and dosage, respecting contraindications, considering the clinical status of the patient and the type of surgery performed [ 2 , 3 , 6 – 8 ]. Incorrect management of perioperative fluid therapy has been shown to have important repercussions in the immediate postoperative period, especially in highly complex patients and surgeries [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Observational study on fluid therapy management in surgical adult patients

et al. 2021

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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.

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State of the art in fluid and volume therapy

Cited by 13 publications

References 78 publications

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Observational study on fluid therapy management in surgical adult patients

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