DOI: https://doi.org/10.22141/2224-0586.3.98.2019.165472

Оptimal strategy of perioperative infusion: pros and cons

O.V. Kravets, O.M. Klygunenko

Abstract


Treatment of abdominal pathology in 80 % cases is conducted surgically. According to the data of the Natio­nal Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2016), postoperative lethality at non-urgent surgical interventions makes up 4 %, in urgent surgery ranges from 19.7 to 23.1 %. Perioperative fluid therapy is a dynamic process of perioperative eradication of hypovolemia, intra-operative support of effective volume of circulatory blood and its postoperative stabilizing. The liberal mode of periope­rative fluid therapy is directed to achieve the hypervolemic hemodilution, is characterized by positive water balance and forms acute hypervolemia, causes the threat of development of interstitial edema of tissues, multiple organ dysfunction of failure. Restrictive mode of fluid therapy allows eradicate hypovolemia under the conditions of normovolemia or “zero water balance”, reduces the threat of surplus liquid, deve­lopment of interstitial edema and multiple organ dysfunction or failure, reduces the number of postoperative complications, period of gastrointestinal tract recovery, duration of in-hospital treatment of patients. The targeted mode of fluid therapy optimizes tissue perfusion by a target management of hemodynamic parameters, reduces duration of in-hospital treatment of patients and level of lethality allowing to support the patient’s growing requirement in oxygen. The analysis of literature data showed absence of the concerted recommendations and algorithms on relatively objective prescriptions to the certain mode of fluid therapy depending on a surgical risk and urgency of surgical intervention, calculation of necessary volume of fluid therapy regarding the stage of perioperative period.

Keywords


perioperative fluid therapy; liberal mode; restrictive mode; targeted mode; review

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