Problems in intraoperative blood loss compensation: strategies of volumetric hemodynamic support (analytical review)

S.V. Kursov, O.V. Biletskyy, K.I. Lyzogub, A.O. Khmyzov, M.G. Klebek

Abstract


Background. An appropriate compensation strategy of a large intraoperative hemorrhage has not been clearly specified. A restrictive mode of fluid resuscitation, which is actively promoted by the authors of the latest recommendations and guidelines, does not a priori insure the safety of major surgeries in high-risk patients. Thus, the aim of this work is to elucidate the problem of the choice of fluid resuscitation strategy under the condition of hemorrhage in patients with a severe comorbidity. Materials and methods. A detailed study of the results of researches on the efficiency of different modes of fluid resuscitation in patients exposed to mainly major surgeries represented in the Internet. Results. The recommendations to use a restrictive mode of fluid resuscitation have a pretty poor evidence base. There has not been estimated the value of the term “a restrictive mode of resuscitation”. These researches did not use a consistent methodology. In different studies, the same infusion volume is regarded as both restrictive and liberal mode of resuscitation. We have noticed the cases of invalid research design. The usage of a restrictive mode of fluid resuscitation while conducting major surgeries in high-risk patients gives cause for a big concern. A promising way-out is the implementation of a new strategy of intraoperative fluid supply, which is directed towards targeted indices of cardiac output, arterial blood pressure and oxygen delivery. The guaranty of its successful usage lies in up-growing possibilities of modern minimally invasive means of hemodynamic monitoring. Conclusions. Currently, a liberal mode of intraoperative infusion treatment is acknowledged as invalid due to the formation of a fluid overstrain of a body and accompanying complications. The usage of a restrictive mode has a poor evidence base. Its application in high-risk patients, especially while carrying out major surgeries, is not safe. The most promising way is a targeted fluid support, which is directed towards the achievement of certain indices of cardiac output, arterial blood pressure and oxygen delivery.


Keywords


blood loss; liberal and restrictive regimes of fluid resuscitation; goal-directed fluid therapy

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DOI: https://doi.org/10.22141/2224-0586.2.81.2017.99689

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