Modern aspects of the volemic management of patients with acute abdominal pathology.

Authors

  • O. V. Kravets

DOI:

https://doi.org/10.26641/2307-0404.2018.4(part1).145675

Keywords:

perioperative infusion therapy, liberal regime, restrictive regime, goal directed therapy

Abstract

In conditions of urgent surgical care, the age of patients, concomitant somatic chronic pathology are factors that significantly increase the risk of postoperative complications and lethality.  The latter in this group of patients is 30-80% and is associated with the development of hypovolemia.  Treatment of the latter is traditionally provided by the routine conduct of a liberal regimen of infusion therapy (IT) to achieve hypervolemic hemodilution by infusion of crystalloid and colloidal drugs.  It was found that the consequences of the liberal regime of IT is the development of acute hypervolemia.  The accumulation of excess fluid forms the development of interstitial edema of tissues, causing a decrease in tissue oxygenation, the development of coagulation disorders and multi-organ dysfunction ̸ inadequacy, inhibits the healing of wounds.  Therefore, in recent years, a restrictive (restricted) IT regimen has become available for clinical use, the goal of which is to achieve normovolemia.  At the same time, evidence-based clinical studies indicate the possibility of using perioperative optimization of hemodynamics in the clinic by individualizing IT in accordance with the indices of central hemodynamics.

Author Biography

O. V. Kravets

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine 

References

Barbieri A, Vanhaecht K, Van Herck P. Effects of clinical pathways in the joint replacement: a meta-ana­lysis. BMC Medicine. 2009;7:32. PUBMED: 19570193.].

Brandstrup B, Svensen C, Engquist A. Hemo­rrha­ge and operation cause a contraction of the extracellular space needing replacement--evidence and implications? A systematic review. Surgery 2006;139(3):419-32. PUBMED: 16546507.

Brandstrup B, Svendsen PE, Rasmussen M. Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?. BritishJournal of Anaes­thesia 2012;109(2):191-9. PUBMED:22710266.

Brandstrup B, Tonnesen H, Beier-Holgersen R. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessorblinded multicenter trial. Annals of Surgery 2003;238(5): 641-8. PUBMED: 14578723.

Chappell D, Jacob M, Hofmann-Kiefer K, Con­zen P,Rehm M. A rational approach to perioperative fluid management. Anesthesiology 2008;109(4):723-40.

Della Rocca G, Vetrugno L, Tripi G, Deana C, Barbariol F, Pompei L. Liberal or restricted fluid admi­nistration: are we ready for a proposal of a restricted intra­operative approach? BMC Anesthesiology 2014;14:62.

How to Cite

1.
Kravets OV. Modern aspects of the volemic management of patients with acute abdominal pathology. Med. perspekt. [Internet]. 2018Dec.3 [cited 2024Mar.28];23(4(part1):87-90. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/145675

Issue

Section

CLINICAL MEDICINE