Formation of initial changes in hemodynamics and fluid compartments in high surgical risk patients under the influence of acute abdominal pathology

Authors

  • O.V. Kravets Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0003-1340-3290
  • V.V. Yekhalov Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0001-5373-3820
  • D.A. Krishtafor Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0003-0942-4099
  • O.O. Zozulia Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Ukraine
  • O.O. Volkov Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Ukraine
  • O.O. Vlasov Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Ukraine

DOI:

https://doi.org/10.26641/2307-0404.2021.3.241962

Keywords:

acute abdominal pathology, dehydration, volume depletion, fluid compartments

Abstract

Among the main factors of pathological changes that accompany acute abdominal pathology are the inflammatory process of the peritoneum and fluid deficiency due to its pathological losses. The aim of our study was to analyze the initial state of fluid compartments of the body and hemodynamics in high surgical risk patients with acute surgical abdominal pathology. There were examined 157 patients with acute abdominal pathology who underwent emergency laparotomy. The presence and severity of fluid deficiency were determined clinically by tissue hydrophilicity test by P.I. Shelestiuk, biochemically – by assessing the levels of hematocrit, hemoglobin, erythrocytes, blood electrolytes, vasopressin (ADH) and brain natriuretic propeptide (proBNP), as well as the mean erythrocyte volume and plasma osmolarity. Variables of fluid compartments of the body and central hemodynamics were studied using the non-invasive bioimpedancemetry. Based on the values of oxygen concentration in arterial and venous blood, total oxygen consumption (VO2) and delivery of oxygen (DO2), oxygen extraction ratio (O2ER) were calculated. The detected changes indicate intravascular fluid deficiency and concomitant hemoconcentration with normal electrolytes levels and plasma osmolarity. In patients with high surgical risk and moderate dehydration according to P.I. Shelestiuk, urgent surgical pathology of the abdominal cavity reduces extracellular fluid volume by 19.1% (p=0.019) of the reference by reducing the volume of the interstitium and intravascular fluid respectively by 20.7% (p=0.002) and 16.3% (p=0.001) of regional values, which forms in patients a state of "volume depletion" of moderate severity. This is accompanied by an increase in the ADH concentration by 16.7% (p=0.041) above reference and normal proBNP levels. Stroke volume decreases by 28.8% (p=0.021) against tachycardia (increase in heart rate by 39.7% (p=0.001) above normal) and vascular spasm (increase in systemic vascular resistance by 86.9% (p=0.001) above reference), which supports the normodynamic type of blood circulation (cardiac index – 3.2 (0.4) l/min/m2) with the decrease in stroke index and peripheral perfusion index by 41.3% (p=0.002) and 55.2% (p=0.002) from reference, respectively. DO2 decreases by 11.1% (p=0.011) from reference with VO2 increased by 16.3% (p=0.004) above reference, which leads to a decrease in oxygen utilization by 7.2% (p=0.041) from reference.

References

Leonov VP., editor. [How to Describe Statistics in Medicine: A Guide for Authors, Editors, and Reviewers]. Moskva: Prakticheskaya medetsuna; 2016. p. 480. Russian.

Fomin PD, Usenko OYu, Bereznytskyi YaS, editors. [Emergency abdominal surgery (standards of organization and professionally oriented algorithms of medical care)]. Kyiv: Library “Zdorove Ukrainy”; 2018. p. 354. Ukrainian.

Aggarwal G, Peden CJ, Quiney NF. Improving Outcomes in Emergency General Surgery Patients: What Evidence Is Out There. Anesth. Analg. 2017;125(4):1403-5. doi: https://doi.org/10.1213/ANE.0000000000002190

Asim M, Alkadi MM, Asim H, Ghaffar A. Dehydration and volume depletion: How to handle the misconceptions. World J Nephrol. 2019;21(1):23-32. doi: https://doi.org/10.5527/wjn.v8.i1.23

Carlisle JB. Risk prediction models for major surgery: composing a new tune. Anaesthesia. 2019;74:7-12. doi: https://doi.org/10.1111/anae.14503

Croskerry P, Cosby KS. Patient Safety in Emergency Medicine. Philadelphia: Lippincott-Williams &Wilkins, PA; 2016. p. 1279

Marx G, Schindler AW, Mosch C, et al. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol. 2016;33(7):488-521. doi: https://doi.org/10.1097/EJA.0000000000000447

Miller TE, Myles PP. Рerioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019;130:825-32. doi: https://doi.org/10.1097/ALN.0000000000002603

Murray D. Improving outcomes following emergency laparotomy. Anaesthesia. 2014;69:300-5. doi: https://doi.org/10.1111/anae.12620

NELA Project Team. The Fifth Patient Report Of The National Emergency Laparotomy Audit. RCoA. London: UK; 2019. p. 59.

Patel N, Durland J, Makaryus AN. Physiology, Cardiac Index. StatPearls. StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539905/

Patel R, Cooper N, Paul Cramp P, Forrest K. Essential Guide to Acute Care. 3rd edition. Wiley-Blackwell, NJ; 2020. p. 240.

Oliver CM, Walker E, Giannaris S, Grocott MPW, Moonesinghe SR. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. British Journal of Anaesthesia. 2015;115(6):849-60. doi: https://doi.org/10.1093/bja/aev350

Tobias A, Ballard BD, Mohiuddin SS. Physiology, Water Balance. StatPearls. StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541059/

Vivekanand KH, Mohankumar K. Clinical Outcome of Emergency Laparotomy: Our Experience at tertiary care centre (A case series). International Journal of Biomedical and Advance Research. 2015;6(10):709-14.

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Published

2021-09-30

How to Cite

1.
Kravets O, Yekhalov V, Krishtafor D, Zozulia O, Volkov O, Vlasov O. Formation of initial changes in hemodynamics and fluid compartments in high surgical risk patients under the influence of acute abdominal pathology. Med. perspekt. [Internet]. 2021Sep.30 [cited 2024Mar.29];26(3):94-100. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/241962

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CLINICAL MEDICINE