Using clinical parameters to guide fluid therapy in high-risk thoracic surgery. A retrospective, observational study

BMC Anesthesiology

Jens Christian Nilsson⁴  Jesper Ravn¹  Kristoffer Lindskov Hansen²  Hasse Møller-Sørensen⁴  Lars Stryhn Bjerregaard³ 

[1]Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, DK-2100, Denmark

[2]Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, DK-2100, Denmark

[3]Section for Surgical Pathophysiology & Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, DK-2100, Denmark

[4]Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, DK-2100, Denmark

关键词: Postoperative complications;    Pulmonary edema;    Pneumonectomy;    Perioperative care;    Fluid therapy;   

Others  :  1212221
DOI  :  10.1186/s12871-015-0072-2

 received in 2015-02-19, accepted in 2015-05-29,  发布年份 2015

【 摘 要 】

Background

Despite extensive research, the debate continues as to the optimal way of guiding intraoperative and postoperative fluid therapy. In 2009 we changed our institutional guideline for perioperative fluid therapy in patients undergoing extrapleural pneumonectomy (EPP) and implemented the use of central venous oxygen saturation and intended low urine output to guide therapy in the early postoperative period. Here we evaluate the consequences of our changes.

Methods

Retrospective, observational study of 30 consecutive patients undergoing EPP; 18 who had surgery before and 12 who had surgery after the changes. Data were collected from patient files and from institutional databases. Outcome measures included: Volumes of administered fluids, fluid balances, length of stays and postoperative complications. Dichotomous variables were compared with Fisher’s exact test, whereas continuous variables were compared with Student’s unpaired t-test or the Wilcoxon Two-Sample Test depending on the distribution of data.

Results

The applied changes significantly reduced the volumes of administered fluids, both in the intraoperative (p = 0.01) and the postoperative period (p = 0.04), without increasing the incidence of postoperative complications. Mean length of stay in the intensive care unit (LOSI) was reduced from three to one day (p = 0.04) after the changes.

Conclusion

The use of clinical parameters to balance fluid restriction and a sufficient circulation in patients undergoing EPP was associated with a reduction in mean LOSI without increasing the incidence of postoperative complications. Due to methodological limitations these results are only hypothesis generating.

【 授权许可】

   
2015 Bjerregaard et al.

【 图 表 】

Fig. 1.

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