Abstract
BackgroundPerioperative fluid therapy management is changing due to the incorporation of different fluids, surgical techniques, and minimally invasive monitoring systems. The objective of this study was to explore fluid therapy management during the perioperative period in our country.MethodsWe designed the Fluid Day study as a cross-sectional, multicentre, observational study. The study was performed in 131 Spanish hospitals in February 2019. We included adult patients undergoing general anaesthesia for either elective or non-elective surgery. Demographic variables were recorded, as well as the type and total volume of fluid administered during the perioperative period and the monitorization used. To perform the analysis, patients were categorized by risk group.ResultsWe recruited 7291 patients, 6314 of which were included in the analysis; 1541 (24.4%) patients underwent high-risk surgery, 1497 (23. 7%) were high risk patients, and 554 (8.7%) were high-risk patients and underwent high-risk surgery; 98% patients received crystalloids (80% balanced solutions); intraoperative colloids were used in 466 patients (7.51%). The hourly intraoperative volume in mL/kg/h and the median [Q1; Q3] administered volume (mL/kg) were, respectively, 6.67 [3.83; 8.17] ml/Kg/h and 13.9 [9.52;5.20] ml/Kg in low-risk patients undergoing low- or intermediate-risk surgery, 6 [4.04; 9.08] ml/Kg/h and 15.7 [10.4;24.5] ml/Kg in high- risk patients undergoing low or intermediate-risk surgery, 6.41 [4.36; 9.33] ml/Kg/h and 20.2 [13.3;32.4] ml/Kg in low-risk patients undergoing high-risk surgery, and 5.46 [3.83; 8.17] ml/Kg/h and 22.7[14.1;40.9] ml/Kg in high-risk patients undergoing high- risk surgery . We used advanced fluid monitoring strategies in 5% of patients in the intraoperative period and in 10% in the postoperative period.ConclusionsThe most widely used fluid was balanced crystalloids. Colloids were used in a small number of patients. Hourly surgery volume tended to be more restrictive in high-risk patients but confirms a high degree of variation in the perioperatively administered volume. Scarce monitorization was observed in fluid therapy management.Trial registrationClinical Trials: NCT03630744.
Highlights
Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgi‐ cal techniques, and minimally invasive monitoring systems
The goal of perioperative fluid therapy is to maintain the body in an optimal state of tissue perfusion and hydration, ensuring adequate hydro-electrolytic homeostasis to provide a correct balance between oxygen tissue supply and demand, avoiding adverse side effects [1,2,3]
These authors pointed out that, despite the implementation of clinical practice guidelines, knowledge of fluid therapy management among physicians is still deficient. This observation was echoed by Cordero et al [11] who observed that more than 40% of specialists consulted believed there was a need for more education in fluid therapy, particular regarding indication, leading the authors to conclude that specific training programs, guidelines, and consensus fluid management protocols are needed
Summary
Perioperative fluid therapy management is changing due to the incorporation of different fluids, surgi‐ cal techniques, and minimally invasive monitoring systems. Incorrect management of perioperative fluid therapy has been shown to have important repercussions in the immediate postoperative period, especially in highly complex patients and surgeries [9]. In a study in surgical patients, Thacker et al [10] showed that a high volume of fluids administered on the day of surgery correlates significantly with longer hospital stay (OR 1.10–1.40) and higher overall cost (OR 1.10–1.50). These authors pointed out that, despite the implementation of clinical practice guidelines, knowledge of fluid therapy management among physicians is still deficient. This observation was echoed by Cordero et al [11] who observed that more than 40% of specialists consulted believed there was a need for more education in fluid therapy, particular regarding indication, leading the authors to conclude that specific training programs, guidelines, and consensus fluid management protocols are needed
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