scholarly journals Assessment of perioperative fluid balance

2009 ◽  
Vol 56 (1) ◽  
pp. 67-76
Author(s):  
R. Sindjelic ◽  
G. Vlajkovic ◽  
D. Markovic ◽  
V. Bumbasirevic
Keyword(s):  
Fluid Balance ◽  
Fluid Therapy ◽  
Perioperative Period ◽  
Fluid Replacement ◽  
Haemodynamic Monitoring ◽  
Resuscitation Fluid ◽  
Golden Standard ◽  
Consistent Manner ◽  
Fluid Replacement Therapy ◽  
Patient’S Outcome

Careful assessment of the fluid balance is required in the perioperative period since appropriate fluid therapy is essential for successful patient's outcome. Haemodynamic monitoring allows understanding the physiology of the circulation and changes of fluid balance in the perioperative period. This is diagnostic aid and guide for fluid replacement therapy. Patient's volume status is frequently assessed by different haemodynamic variables that could be targeted as the endpoints for fluid therapy and resuscitation. Fluid balance is the crucial factor in the maintenance of haemodynamic stability, tissue oxygenation and organ function. When the haemodynamic monitoring is applied in a rigorous and consistent manner, it reduces mortality and length of stay as well as costs incurred. There are a number of tests which describe the effectiveness of the invasive haemodynamic monitoring procedures usage. Since the pulmonary artery catheter (PAC) had been introduced into clinical practice it was considered as a golden standard for cardiac output measurements, haemodynamic and fluid balance assessment. Nevertheless, in previous 10 years new minimally invasive and noninvasive simple techniques for haemodynamic monitoring and patient's hydroelectricity status evaluation have been developed. They can replace PAC under different clinical circumstances and some of these techniques additionally allow a more refined perioperative fluid assessment. The aim of this article is to describe actually technique of haemodynamic measurement and assessment of fluid status and therapy in perioperative period.

Anaphylactic shock: are we doing enough and with the right timing and order?

2015 ◽  
Vol 53 (3) ◽  
pp. 191-198
Author(s):  
H. Bălan ◽  
Adriana Gurghean
Keyword(s):  
Anaphylactic Shock ◽  
Good Practice ◽  
Fluid Replacement ◽  
First Line ◽  
Good Opportunity ◽  
First Line Therapy ◽  
Line Therapy ◽  
Practice Parameters ◽  
Golden Standard ◽  
The Right

Abstract Anaphylactic shock became, unfortunately, a common presence in Romanian mass-media, due to some fatal cases in the last months. The coincidence that in December 2014 the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy Asthma and Immunology released Practice parameters offers a good opportunity to renew for all practitioners what is now considered the “golden standard” of good practice. Epinephrine must be considered the cornerstone and the most urgent measure to be applied in these cases, immediately after the diagnosis. A very important notice is to forget the administration of antihistamines or corticosteroids as first line therapy instead of epinephrine. Proper positioning of the subjects and quick fluid replacement (1-2 l of normal saline in a few minutes) are also mandatory.

scholarly journals Perioperative Cumulative Fluid Balance and Its Association with an Increase in Costs after Major Surgery

2018 ◽  
Vol 7 (9) ◽  
pp. 227
Author(s):  
Tak Oh ◽  
Jung-Won Hwang ◽  
Young-Tae Jeon ◽  
Sang-Hwan Do
Keyword(s):  
Fluid Balance ◽  
Medical Records ◽  
Hospital Costs ◽  
Perioperative Period ◽  
Major Surgery ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Input ◽  
Estimated Blood Loss ◽  
Cumulative Fluid Balance

Positive fluid balance (FB) during the perioperative period may increase the incidence of postoperative complications, which may lead to longer hospitalization and higher hospital costs. However, a definitive association between positive FB and hospital costs has not yet been established. This retrospective observational study examined the association between perioperative FB and hospital costs of patients who underwent major surgical procedures. Medical records of patients who underwent major surgery (surgery time >2 h, estimated blood loss >500 mL) from January 2010 to December 2017 were analyzed to determine the associations between calculated FB (%, total input fluid—output fluid in liter/weight (kg) at admission) and total hospital cost ($). The analysis included medical data of 7010 patients. Multivariable linear regression analyses showed that a 1% increase in FB in postoperative day (POD) 0 (24 h), 0–1 (48 h), 0–2 (72 h), and 0–3 (96 h) significantly increased the total cost by $967.8 (95% confidence interval [CI]: 803.4–1132.1), $688.8 (95% CI: 566.3–811.2), $591 (95% CI: 485.7–696.4), and $434.2 (95% CI: 349.4–519.1), respectively (all p < 0.001). Perioperative cumulative FB was positively associated with hospital costs of patients who underwent major surgery.

scholarly journals Fluid Overload

2021 ◽  
Vol 8 ◽  
Author(s):  
Bernie Hansen
Keyword(s):  
Fluid Therapy ◽  
Clinical Studies ◽  
Observational Studies ◽  
Fluid Intake ◽  
Fluid Overload ◽  
Body Cavity ◽  
Positive Fluid Balance ◽  
Intravenous Fluid Therapy ◽  
Maintenance Fluid ◽  
Resuscitation Fluid

Fluid overload (FO) is characterized by hypervolemia, edema, or both. In clinical practice it is usually suspected when a patient shows evidence of pulmonary edema, peripheral edema, or body cavity effusion. FO may be a consequence of spontaneous disease, or may be a complication of intravenous fluid therapy. Most clinical studies of the association of FO with fluid therapy and risk of harm define it in terms of an increase in body weight of at least 5–10%, or a positive fluid balance of the same magnitude when fluid intake and urine output are measured. Numerous observational clinical studies in humans have demonstrated an association between FO, adverse events, and mortality, as have two retrospective observational studies in dogs and cats. The risk of FO may be minimized by limiting resuscitation fluid to the smallest amount needed to optimize cardiac output and then limiting maintenance fluid to the amount needed to replace ongoing normal and pathological losses of water and sodium.

Perioperative monitoring: transoesophageal echocardiography

ESC CardioMed ◽  
2018 ◽  
pp. 2677-2679
Author(s):  
Luc A. Pierard
Keyword(s):  
High Risk ◽  
Myocardial Ischaemia ◽  
Invasive Procedure ◽  
Perioperative Period ◽  
Transoesophageal Echocardiography ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Valve Disease ◽  
Haemodynamic Monitoring ◽  
Left Ventricular Outflow

Transoesophageal echocardiography (TOE) is a widely available and relatively non-invasive procedure. Skills are required to avoid complications and inaccurate interpretation. TOE should not be used in all patients as there is no evidence that haemodynamic monitoring by TOE accurately stratifies risk or predicts outcome. It is recommended in patients who develop acute, sustained, and unexplained hypotension during surgery or in the perioperative period to identify its aetiology and distinguish between hypovolaemia, pulmonary embolism, myocardial ischaemia, cardiac tamponade, and dynamic left ventricular outflow tract obstruction. It is also recommended if unexplained hypoxaemia develops. TOE monitoring may be useful in patients with severe valve disease during high-risk non-cardiac surgery: specific parameters for each valve disease should be monitored. Myocardial ischaemia can be identified by TOE. The use of TOE for detection of myocardial ischaemia should be considered when ST-segment changes are observed and may even be considered in patients at high risk of developing myocardial ischaemia.

Disseminated Intravascular Coagulation in Dengue Haemorrhagic Fever

1975 ◽  
Author(s):  
T. Himawan ◽  
L. K. Kho ◽  
S. Melani
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Bleeding Time ◽  
Dengue Shock Syndrome ◽  
Dengue Haemorrhagic Fever ◽  
Fluid Replacement ◽  
Haemorrhagic Fever ◽  
Laboratory Findings ◽  
Intravascular Coagulation ◽  
Prolonged Bleeding Time ◽  
Fluid Replacement Therapy

The most dreaded complications of dengue fever are haemorrhagic manifestations (Dengue Haemorrhagic Fever) and shock (Dengue Shock Syndrome). We have the opportunity to carry out clinical and haematological studies on 68 selected cases of disseminated intravascular coagulation (DIC) occuring in DHF. Shock was encountered in the majority of the cases (70.6%), while haemorrhagic manifestations were observed in all the children. Other laboratory findings revealed the presence of anemia in 38.1%. hemo-concentration in 72.6% ; the W. B.C. varied between 1,600 and 39,400, thrombocytopenia 83.8%. Fragmented red cells were found in the periferal blood smear. Prolonged bleeding time 69.3%; prolonged clotting time 48.7%; prolonged prothrombine time 66.6%; prolonged partial thromboplastin time 56% ; fibrinogenopenia 80% and positive tourniquet test 85.7%.The management was directed to the improvement of the general condition with intravenous fluid replacement therapy, electrolytes, plasma expanders or blood. Heparin was administered to 36 children with severe DIC. The mortality rate was high (33.8%).

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