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Fluid Management (fluid + management)
Selected AbstractsPerioperative fluid management: prospective auditINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008S. R. Walsh Summary Background:, Postoperative fluid management is a core surgical skill but there are few data regarding current fluid management practice and the incidence of potential fluid-related complications in general surgical units. We conducted a prospective audit of postoperative fluid management and fluid-related complications in a consecutive cohort of patients undergoing midline laparotomy. Methods:, Over a 6-month period, the peri-operative fluid management of 106 consecutive patients was prospectively audited. Serum electrolyte data, fluid balance data, co-morbidities, operative and anaesthetic variables and quantities of fluid and electrolytes prescribed were recorded. The development of fluid-related and other complications was noted. Results:, There were no correlations between routinely available fluid balance parameters and the quantities of fluid and electrolytes prescribed, suggesting that doctors do not consult fluid balance data when prescribing. Fifty-seven patients (54%) developed at least one fluid-related complication. These patients received significantly greater volumes of fluid and sodium each day postoperatively. They had higher rates of other non-fluid-related complications and death. They had a longer hospital stay. In a multivariate model, mean daily fluid load predicted the development of fluid-related complications. Conclusion:, Fluid prescription practice in general surgical units is sub-optimal, resulting in avoidable iatrogenic complications. Involvement of senior staff, education and possibly the introduction of prescribing protocols may improve the situation. [source] ,Liberal' vs. ,restrictive' perioperative fluid therapy , a critical assessment of the evidenceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009M. BUNDGAARD-NIELSEN Background: Several studies have assessed the effect of a ,liberal' vs. a ,restrictive' perioperative fluid regimen on post-operative outcome. The literature was reviewed in order to provide recommendations regarding perioperative fluid regimens. Methods: A PubMed search identified randomized clinical trials and cited studies, comparing two different fixed fluid volumes on post-operative clinical outcome in major surgery. Studies were assessed for the type of surgery, primary and secondary outcome endpoints, the type and volume of administered fluid and the definition of the perioperative period. Also, information regarding perioperative care and type of anaesthesia was assessed. Results: In the seven randomized studies identified, the range of the liberal intraoperative fluid regimen was from 2750 to 5388 ml compared with 998 to 2740 ml for the restrictive fluid regimen. The period for fluid therapy and outcome endpoints were inconsistently defined and only two studies reported perioperative care principles and discharge criteria. Three studies found an improved outcome (morbidity/hospital stay) with a restrictive fluid regimen whereas two studies found no difference and two studies found differences in the selected outcome parameters. Conclusion: Liberal vs. restrictive fixed-volume regimens are not well defined in the literature regarding the definition, methodology and results, and lack the use of or information on evidence-based standardized perioperative care-principles (fast-track surgery), thereby precluding evidence-based guidelines for procedure-specific perioperative fixed-volume regimens. Optimization of perioperative fluid management may include a combination of fixed crystalloid administration to replace extra-vascular losses and avoiding fluid excess, together with individualized goal-directed colloid administration to maintain a maximal stroke volume. [source] Stroke volume averaging for individualized goal-directed fluid therapy with oesophageal DopplerACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009C. C. JŘRGENSEN Background: An individualized fluid optimization strategy, based on maximization of cardiac stroke volume (SV) with colloid boluses (goal-directed therapy), improves outcome after surgery. Oesophageal Doppler (OD) is used for SV maximization in most randomized studies, but evidence-based guidelines for the SV maximization procedure are lacking and variation in SV may influence the indication for fluid administration. We measured beat-to-beat OD SV before and after fluid optimization in order to estimate the number of heartbeats for which SV needs to be averaged to provide an acceptable accuracy for goal-directed therapy with this technology. Methods: Twenty patients scheduled for surgery were anaesthetized, followed by OD SV assessment. Thirty seconds of beat-to-beat data were recorded before and after volume optimization performed by successive boluses of 200 ml colloid until SV did not increase ,10%. SV variability was assessed before and after the volume optimization when SV was measured beat to beat and when it was averaged over 2,10 heartbeats. Results: Nineteen (95%) and 17 (85%) patients demonstrated an SV variability ,10% before and after volume optimization, respectively, when SV was measured beat to beat. However, when SV was averaged over 10 heartbeats, only two (10%) and one (5%) of the patients demonstrated an SV variability ,10% before and after optimization, respectively (P<0.0001). Conclusion: OD SV variability is significantly reduced and reaches an acceptable level when SV is averaged over 10 heartbeats. The use of a shorter averaging period for SV may lead to incorrect volume administration in goal-directed fluid management. [source] Preoperative risk assessment and prevention of complications in patients with esophageal cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2010Brechtje A. Grotenhuis MD Abstract In this review the preoperative risk assessment and prevention of complications in patients undergoing esophagectomy for cancer is discussed. Age, pulmonary and cardiovascular condition, nutritional status, and neoadjuvant chemo(radio)therapy are known predictive factors. None of these factors is a valid exclusion criterion for esophagectomy, but may help in careful patient selection. Both anesthetists and surgeons play an important role in intraoperative risk reduction by means of appropriate fluid management and application of optimal surgical techniques. J. Surg. Oncol. 2010; 101:270,278. © 2010 Wiley-Liss, Inc. [source] Inappropriate perioperative fluid management in children: time for a solution?!PEDIATRIC ANESTHESIA, Issue 3 2007PER-ARNE LÖNNQVIST MD DEAA FRCA PhD No abstract is available for this article. [source] Non-cardiogenic pulmonary edema during basiliximab induction in three adolescent renal transplant patientsPEDIATRIC TRANSPLANTATION, Issue 4 2003Fatai O. Bamgbola Abstract:, Background:, Introduction of the anti-CD-25 mAb basiliximab into renal transplant protocols has reduced the incidence of acute rejection. However, its side-effect profile is still unfolding. We report three adolescents who developed severe non-cardiogenic PE within 2 days of renal transplantation. Methods:, Pretransplant cardiorespiratory evaluation was normal in all cases. Transplant immunosuppression consisted of basiliximab induction, corticosteroids, and tacrolimus. Patients received standard fluid management during and after the transplant surgery. Case reports:, Patients 1 and 2 were 17- and 21-yr-old females. Pretransplant Hct values were 35 and 25% respectively. Each received 5-L normal saline during surgery. EBL was 200 and 500 mL in patients 1 and 2, respectively. There was immediate post-operative diuresis. Both developed non-cardiogenic PE by POD no. 2. BIPAP and PRVC were administered respectively. In both cases PE resolved within 1 wk. Patient 3 was a 19-yr-old male with pretransplant Hct of 43% who received a cadaveric renal transplant after 23.5-h cold-ischemia; 3.5 L normal saline was given during surgery. EBL was 100 mL. Non-cardiogenic PE ensued on POD no. 2 warranting assisted ventilation. The patient died following a sudden cardiopulmonary arrest on POD no. 3. Conclusions:, Potential mechanisms for the development of PE include cytokine release from basiliximab with increased capillary permeability, volume overload and ischemic-reperfusion injury. Improved awareness of this potential complication, prudent fluid management, and efforts to minimize graft-ischemia are recommended to prevent further cases. [source] Heart failure self-management education: a systematic review of the evidenceINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2009Suzanne Austin Boren PhD MHA Abstract Objective, The objective of this systematic review is to identify educational content and techniques that lead to successful patient self-management and improved outcomes in congestive heart failure education programs. Methods, MEDLINE, CINAHL and the Cochrane Central Register of Controlled Trials, as well as reference lists of included studies and relevant reviews, were searched. Eligible studies were randomised controlled trials evaluating congestive heart failure self-management education programs with outcome measures. Two of the investigators independently abstracted descriptive information, education content topics and outcomes data. Results, A total of 7413 patients participated in the 35 eligible congestive heart failure self-management education studies. The congestive heart failure self-management programs incorporated 20 education topics in four categories: (i) knowledge and self-management (diagnosis and prognosis, pathophysiology of how congestive heart failure affects the body, aims of treatment, management and symptoms, medication review and discussion of side-effects, knowing when to access/call the general practitioner, communication with the physician, follow up for assessment or reinforcement); (ii) social interaction and support (social interaction and support, stress, depression); (iii) fluids management (sodium restriction, fluid balance, daily measurement of weight, ankle circumference, self-monitoring and compliance relative to fluids); and (iv) diet and activity (dietary assessment and instructions, physical activity and exercise, alcohol intake, smoking cessation). A total of 113 unique outcomes in nine categories (satisfaction, learning, behaviour, medications, clinical status, social functioning, mortality, medical resource utilisation and cost) were measured in the studies. Sixty (53%) of the outcomes showed significant improvement in at least one study. Conclusion, Educational interventions should be based on scientifically sound research evidence. The education topic list developed in this review can be used by patients and clinicians to prioritise and personalise education. [source] | ||||||||||