DOI: https://doi.org/10.22141/2224-0586.5.92.2011.143249

Perioperative infusion therapy with different volume protocols in patients with moderate surgical risk undergoing emergency laparotomy

O.V. Kravets

Abstract


To assess the effectiveness of the liberal and restrictive protocol of perioperative infusion therapy in emergency laparotomy, we examined 100 patients. The degree of surgical and anesthetic risk according to the ASA scale was IIE, the surgical risk on the POSSUM scale was 1–5 % and corresponded to the average surgical risk. All patients underwent preoperative preparation for 2 hours in the intensive care unit in the volume of 2870 ± 540 ml and 1733 ± 340 ml, respectively, in groups, with a calculated infusion load of 80–120 and 40–60 ml/kg/day. Patients were examined clinically, instrumentally and laboratorially. The study proved that acute surgical pathology in patients with moderate surgical risk is accompanied by the maintenance of a normal total volume of fluid with a significant redistribution of water sectors in the body such as plasma deficiency with development of hypovolemia, formation of intracellular dehydration, the initial increase in the volume of the interstitial space. The change in water sectors is combined with the development of relative hyperdynamia due to an increase in the total peripheral resistance and heart rate. The use of a restrictive strategy of infusion therapy in patients with moderate surgical risk allows restoring the physiological volumes of water sectors in the body and forms a normodynamic type of circulation from day 3 of postoperative period.

Keywords


restrictive protocol; liberal protocol; perioperative infusion therapy; water sectors; central hemodynamics; emergency laparatomy

Full Text:

PDF

References


Mythen M.G., Swart M., Acheson N., Crawford R., Jones K., Kuper M. et al. Perioperative fluid management: Consensus statement from the enhanced recovery partnership // Perioperative Medicine. 2012; 1: 2. [PUBMED: 24764518].

Rahbari N.N., Zimmermann J.B., Schmidt T., Koch M., Weigand M.A., Weitz J. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery // British Journal of Surgery. 2009; 96(4): 331-41. [PUBMED: 19283742].

Nisanevich V., Felsenstein I., Almogy G., Weissman C., Einav S., Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery // Anesthesiology. 2005; 103(1): 25-32.

Hartog C., Reinhart K. CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients // Intensive Care Med. 2009; 35(8): 1337-42. http://dx.doi.org/10.1007/s00134-009-1521-5. 27.

Mythen M., Vercueil A. Fluid balance // Vox Sang. 2004; 87, Suppl. 1: 77-81.

Sark Y., Vincent J.L., Reinhart K., Groeneveld J., Michalopoulos A., Sprung C.L., Artigas A., Ranieri V.M.; Sepsis Occurrence in Acutely Ill Patients Investigators. High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury // Chest. 2005; 128: 3098-3108.




Copyright (c) 2018 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта