Assessment of fluid balance in different regimens of infusion therapy of high surgical risk patients with acute abdominal pathology.

Authors

DOI:

https://doi.org/10.26641/2307-0404.2019.3.181877

Keywords:

goal-directed regimen, restrictive regimen, infusion therapy, water balance, acute abdominal pathology, high surgical risk

Abstract

Fluid disorders always accompany acute pathology of abdominal organs. To conduct comparative analysis of efficiency of the goal-directed and restrictive regimens of infusion therapy of replenishment of volume depletion in high surgical risk patients with acute abdominal pathology 80 patients, operated by urgent laparotomy were studied. Patients were divided into two groups. In the first group (n=40) a goal-directed infusion therapy was conducted, in the second (n=40) – restrictive. Rheographic method was used to investigate the performance of water sectors of the organism, daily and cumulative water balances were defined, the percentage of excessive fluid was determined and estimated. In patients of the first group an increase in plasma volume by 11% (p<0.05), exceeding of the volume of interstitium by 14% (p<0.05) and the volume of extracellular fluid by 7% (p<0.05) on the 1st and 2nd day were noted. From the 3 to 7th day a reduction in extracellular fluid to 91.5% (p<0.05) of the norm was noted. Recovery of all the studied parameters was detected on the 10th postoperative day, when the percent of excessive fluid reached 9.6%. In patients of the second group there was restoration of plasma volume to normal in reduced by 10% (p<0.05) – 12% (p<0.05) from the norm of the interstitium volume, respectively to the 1st and 2nd day after surgery. From the 3d day there was a significant restoration to normal of all the studied parameters, which coincided with the “zero” values of the daily water balance and sufe limits of the percent of excess fluid, which reached 6.1% on the 10th day of treatment. Thus, the goal-directed infusion therapy allows to perform the correction of volume depletion in high surgical risk patients with acute abdominal pathology by increasing intravascular volume to excessive and increase of interstitium volume on 1st and 2nd day, development of a mild volume depletion from the 3d to 5th day, maintainance of the percentage of excessive fluids within safe borders. Restrictive mode of infusion therapy normalizes fluid balance of water sectors due to restoration of plasma volume in 6 hours of treatment and maintains it within the limits of the norm during all the postoperative period, preventis the development of interstitial oedema, ensures the "zero" daily water balance and limits the postoperative growth of the percentage of excess fluid.

 

Author Biography

O. V. Kravets

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Anesthesiology, intensive care medicine and emergency conditions FPE
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

References

Bereznytskiy Ya, compiler. [Standards of organi­zation and professionally oriented protocols of emer­gency care for patients with surgical abdominal pathology (departmental instruction)]. Dnipro: Dnipro-VAL. 2010;256. Ukrainian.

Pearse RM, Harrison DA, MacDonald N, Gil­lies MA, Blunt M, Ackland G. Effect of a perioperative, cardiac outputguided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311:2181-90. doi: https://doi.org/10.1001/jama.2014.5305

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

Vallet B, Blanloeil Y, Cholley B, Orliaguet G, Pierre S, Tavernier B. Guidelines for perioperative haemo­dy­namic optimization. Ann Fr Anesth Reanim. 2013;32:151-8. doi: https://doi.org/10.1016/j.annfar.2013.09.010

Hoste K, Maitland CS, Brudney R, Mehta J-L, Vincent D, Yates JA, Kellum MG, Mythen AD, Shaw JG. Hardman. Four phases of intravenous fluid therapy: a conceptual model. BJA. 2014;113(5):740-7. doi: https://doi.org/10.1093/bja/aeu300

Intravenous fluid therapy in adults in hospital: clinical guideline CG174 (2017) London: National Insti­tute for Health and Care Excellence. Available from: https://www.nice.org.uk/guidance/cg174

Kyle UG, Bosaeus I, De Lorenzo AD. Bioelectri­cal impedance analysis-part II: utilization in clini­cal practice. Clin Nutr. 2014;23(6):1430-53. doi: https://doi.org/10.1016/j.clnu.2004.09.012

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

Corcoran T, Rhodes JE, Clarke S, et al. Periope­rative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012;114:640-51. doi: https://doi.org/10.1213/ANE.0b013e318240d6eb

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:

Iain Anderson et al. Update to the high-risk patient released by RCS England. NELA Project Team. Fourth Patient Report of the National Emergency Laparotomy Audit RcoA. Healthcare Quality Impro­vement Partnership as part of the National Clinical Audit Programme on behalf of NHS England and the Welsh Government, UK. Produced by the Publications Depart­ment Royal College of Anaesthetists, London. 2018;135. Available from: https://www.rcoa.ac.uk/news-and-bulle­tin/rcoa-news-and-statements/fourth-patient-nela-audit-report-published

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. doi: https://doi.org/10.7439/ijbar.v6i10.2578

How to Cite

1.
Kravets OV. Assessment of fluid balance in different regimens of infusion therapy of high surgical risk patients with acute abdominal pathology. Med. perspekt. [Internet]. 2019Nov.5 [cited 2024Dec.23];24(3):39-45. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/181877

Issue

Section

CLINICAL MEDICINE