scholarly journals Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Duo Duo Wang ◽  
Yun Li ◽  
Xian Wen Hu ◽  
Mu Chun Zhang ◽  
Xing Mei Xu ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Fluid Therapy ◽  
Spinal Surgery ◽  
Postoperative Delirium ◽  
Urine Volume ◽  
Length Of Hospital Stay ◽  
Interquartile Range ◽  
Ringer’S Solution ◽  
Goal Directed Fluid Therapy ◽  
Lactated Ringer's Solution

Abstract Background Postoperative delirium (POD) is a common phenomenon after spinal surgery. Intraoperative fluid management may affect POD. The aim of this study was to compare the effects of restrictive fluid therapy (RF) with those of goal-directed fluid therapy (GDT) on POD. Methods A total of 195 patients aged ≥ 50 years who underwent spinal surgery were randomly divided into two groups: the RF group and the GDT group. In group RF, a bolus of lactated Ringer’s solution was administered at a dose of 5 mL·kg-1 before the induction of anesthesia, followed by a dose of 5 mL·kg-1·h-1 until the end of surgery. For patients in the GDT group, in addition to the initial administration of lactated Ringer’s solution at 5 mL·kg-1, the subsequent fluid therapy was adjusted by using a continuous noninvasive arterial pressure (CNAP) monitoring system to maintain pulse pressure variation (PPV) ≤ 14%. The primary endpoint was the incidence of POD, assessed once daily with the Confusion Assessment Method-Chinese Reversion (CAM-CR) scale at 1–3 days postoperatively. The secondary endpoints were intraoperative fluid infusion volume, urine volume, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), regional cerebral oxygen saturation (rSO2) value, lactic acid value, and visual analog scale (VAS) pain score at 1–3 days after surgery. Moreover, postoperative complications and the length of hospital stay were recorded. Results The incidence of POD was lower in the GDT group than in the RF group (12.4% vs 4.1%; P = 0.035) in the first 3 days after spine surgery. Compared to group RF, group GDT exhibited a significantly increased volume of intraoperative lactated Ringer’s solution [1500 (interquartile range: 1128 to 1775) mL vs 1000 (interquartile range: 765 to 1300) mL, P < 0.001] and urine volume [398 (interquartile range: 288 to 600) mL vs 300 (interquartile range: 200 to 530) mL, P = 0.012]. Intraoperative MAP, CI and rSO2 values were higher in the GDT group than in the RF group (P < 0.05). Moreover, the length of hospital stay [17.0 (14 to 20) days versus 14.5 (13 to 17.0) days, P = 0.001] was shorter in the GDT group than in the RF group. Conclusions GDT reduced the incidence of POD in middle- and old-aged patients undergoing spinal surgery possibly by stabilizing perioperative hemodynamic and improving the supply and demand of oxygen. Trial registration ChiCTR2000032603; Registered on May 3, 2020.

scholarly journals Efficacy of Goal-Directed Fluid Therapy Monitored by Pulse-Pressure Variation Using a C ontinuous Non-Invasive Arterial Pressure Monitoring System (the CNAPTM System) During Parathyroidectomy in Patients with End-Stage Renal Failure - A randomized trial

2019 ◽  
Author(s):  
Jie Song ◽  
Xiaofen Liu ◽  
Weiwei Jiang ◽  
Jiayou Wang ◽  
Yun Li ◽  
...  
Keyword(s):  
Renal Failure ◽  
Arterial Pressure ◽  
Fluid Therapy ◽  
Normal Saline ◽  
Fluid Management ◽  
Pressure Variation ◽  
End Stage Renal Failure ◽  
Intraoperative Period ◽  
Goal Directed Fluid Therapy ◽  
End Stage

Abstract Background: There are no well-recognized guidelines for intraoperative fluid management in patients with end-stage renal failure (ESRF) . Goal-directed fluid therapy (GDFT) is a concept of perioperative fluid management that improves patients’ prognosis. Dynamic indicators better predict fluid response than static indicators. Aim: In this study, we assessed a GDFT protocol with monitoring of pulse pressure variation (PPV) in patients with ESRF undergoing parathyroidectomy. Methods: The study included 102 patients who underwent elective parathyroidectomy. They were randomized to a control group (restrictive group, n = 51) that was managed with a restricted fluid regimen or a PPV group (GDFT group, n = 51) that was given a normal saline infusion and was monitored for change in PPV during the intraoperative period. If PPV reached >13%, 250 mL normal saline was administered over 15 min. Ephedrine was given at increments of 6 mg to keep mean arterial pressure >65 mmHg . Hemodynamic variables in the perioperative period were recorded. The primary endpoint was the occurrence of postoperative hypotension. Results: The occurrence of postoperative hypotension in the GDFT group was lower than in the restrictive group (0 vs. 11.67%, P = 0.027). The patients with complications in the GDFT group was lower than in the restrictive group (35.3% vs. 54.9%, P = 0.047). The volume of saline infused during the intraoperative period was 364 (219-408) mL in the GDFT group and 50 (50-50) mL in the restrictive group ( P = 0.001). Ephedrine was given to 16/51 (29.4%) of the GDFT group and 27/51 (52.9%) of the restrictive group ( P = 0.027). Conclusion: The use of goal-directed fluid therapy with the dynamic PPV indicator in patients with ESRF undergoing parathyroidectomy guides the administration of infused fluids, with reduced incidence of postoperative hypotension.

scholarly journals Lactated Ringer's solution or 0.9% sodium chloride as fluid therapy in pigeons (Columba livia) submitted to humerus osteosynthesis

2015 ◽  
Vol 35 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Adriano B. Carregaro ◽  
Martielo I. Gehrcke ◽  
Jenifer S. Marques ◽  
André N.E. Silva ◽  
Kleber T. Gomes
Keyword(s):  
Sodium Chloride ◽  
Fluid Therapy ◽  
Physical Restraint ◽  
Respiratory Acidosis ◽  
Columba Livia ◽  
Acid Base Balance ◽  
Acid Base ◽  
Ringer’S Solution ◽  
Base Balance ◽  
Lactated Ringer's Solution

The study aimed to compare the effects of intraosseous infusion of lactated Ringer's and 0.9% sodium chloride solutions on the electrolytes and acid-base balance in pigeons submitted to humerus osteosynthesis. Eighteen pigeons were undergoing to isoflurane anesthesia by an avalvular circuit system. They were randomly assigned into two groups (n=9) receiving lactated Ringer's solution (LR) or 0.9% sodium chloride (SC), in a continuous infusion rate of 20mL/kg/h, by using an intraosseous catheter into the tibiotarsus during 60-minute anesthetic procedure. Heart rate (HR), and respiratory rate (RR) were measured every 10 min. Venous blood samples were collected at 0, 30 and 60 minutes to analyze blood pH, PvCO2, HCO3 -, Na+ and K+. Blood gases and electrolytes showed respiratory acidosis in both groups during induction, under physical restraint. This acidosis was evidenced by a decrease of pH since 0 min, associated with a compensatory response, observed by increasing of HCO3 - concentration, at 30 and 60 min. It was not observed any changes on Na+ and K+ serum concentrations. According to the results, there is no reason for choosing one of the two solutions, and it could be concluded that both fluid therapy solutions do not promote any impact on acid-base balance and electrolyte concentrations in pigeons submitted to humerus osteosynthesis.

scholarly journals Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Shan-Han Yang ◽  
Yi-Shiuan Lin ◽  
Chien-Nan Lee ◽  
Ya-Jung Cheng ◽  
Ying-Hsi Chen ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Stroke Volume ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Fluid Therapy ◽  
Fluid Challenge ◽  
Fixed Dose ◽  
Control Group ◽  
Crystalloid Fluid ◽  
Goal Directed Fluid Therapy

Background. Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation. Method. In total, 71 consecutive full-term pregnant women were randomly divided into a control group ( n = 34 ) and a GDFT group ( n = 37 ). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles. Result. Women in the GDFT group received more fluid than did those in the control group ( 1132 ± 108 vs. 1247 ± 202  mL; p = 0.0044 ), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864 ) and norepinephrine dose ( 12.5 ± 10.6 vs. 15.1 ± 12.8  mcg, respectively; p = 0.3512 ) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332 ). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups. Conclusion. ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.

Effects of hypertonic saline versus lactated Ringer's solution on cerebral oxygen transport during resuscitation from hemorrhagic shock

1986 ◽  
Vol 64 (4) ◽  
pp. 627-632 ◽  
Author(s):  
Donald S. Prough ◽  
J. Carson Johnson ◽  
David A. Stump ◽  
Edward H. Stullken ◽  
Galen V. Poole ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Hemorrhagic Shock ◽  
Hypertonic Saline ◽  
Oxygen Transport ◽  
Systemic Hemodynamics ◽  
Cerebral Oxygen ◽  
Systemic Hemodynamic ◽  
Content Type ◽  
Ringer’S Solution ◽  
Lactated Ringer's Solution

✓ Hypertonic saline successfully restores systemic hemodynamics in dogs and humans with severe hemorrhagic shock and, in contrast to lactated Ringer's solution, does not increase intracranial pressure (ICP). This study compares cerebral oxygen delivery in 12 dogs subjected to hemorrhagic shock by the rapid removal of blood (mean arterial pressure of 40 mm Hg maintained for 30 minutes), and then resuscitated with lactated Ringer's solution (six dogs) or 7.5% saline solution (six dogs) to restore systolic arterial pressure. Both solutions effectively restored systemic hemodynamic stability, increasing cardiac output and systolic blood pressure while decreasing mean and diastolic arterial pressure and systemic vascular resistance. The ICP was significantly lower after resuscitation in the hypertonic saline group (p < 0.05), but cerebral blood flow, which had decreased during shock, was not restored by either fluid, and cerebral oxygen transport fell further secondary to a hemodilutional reduction of hemoglobin. Although hypertonic saline may improve systemic hemodynamics and maintain a low ICP during resuscitation, it fails, as does Ringer's solution, to restore cerebral oxygen transport to prehemorrhagic shock levels.

scholarly journals Fluid expansion improve ventriculo-arterial coupling in preload patients: a prospective observational study

2020 ◽  
Author(s):  
Pierre Huette ◽  
Osama Abou Arab ◽  
Dan Longrois ◽  
Pierre-Grégoire Guinot
Keyword(s):  
Arterial Pressure ◽  
Prospective Observational Study ◽  
Fluid Challenge ◽  
Area Under The Curve ◽  
Coupling Ratio ◽  
Ringer’S Solution ◽  
Arterial Blood ◽  
Before And After ◽  
Lactated Ringer's Solution ◽  
Ejection Pressure

Abstract Background Given that the ventricular and arterial systems operate simultaneously, ventricular-arterial (V-A) coupling (i.e the EA/Ees ratio) determines the stroke volume and ejection pressure (i.e. arterial blood pressure). Methods 30 patients admitted to cardio-thoracic ICU in whom the physician decided to perform FC were included. Arterial pressure, cardiac output (CO), EA, and ELV, were measured before and after FC with 500 ml of lactated Ringer's solution. Fluid responders were defined as patients with more than a 15% increase in SV after fluid challenge. V-A coupling was evaluated by the ratio EA/Ees. Results Twenty-three (77%) of the 30 patients included in the study were fluid responders. Before FC, responders had higher mean EA and EA/Ees ratio. FC significantly increased mean arterial pressure, LVEF, SV and CO, and significantly decreased SVRi, EA and consequently the EA/Ees ratio. A pre-challenge EA/Ees ratio greater than 1.4 was predictive of fluid responsiveness (area under the curve [95% confidence interval]: 0.84 [0.66‒1]; p < 0.0001). Conclusions In FC responders, V-A coupling was characterized by a higher pre-challenge EA/Ees ratio (due to a higher EA). FC improve V-A coupling ratio by decreasing EA but not Ees.

scholarly journals P-P06 Ward based goal directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: a feasibility randomised controlled trial [ISRCTN 36077283]

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Farid Froghi ◽  
Fiammetta Soggiu ◽  
Federico Ricciardi ◽  
Cecilia Vindrola-Padros ◽  
Lefteris Floros ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cardiac Output ◽  
General Surgery ◽  
Fluid Therapy ◽  
Early Stage ◽  
Controlled Trial ◽  
Severe Disease ◽  
Randomised Trial ◽  
Length Of Hospital Stay ◽  
Goal Directed Fluid Therapy

Abstract Background Goal directed fluid therapy (GDFT) based on cardiac output assessment has been shown to reduce complications and improve survival for people undergoing major general surgery. There are no reports of cardiac output evaluation being used to optimise the fluid administration for patients with acute pancreatitis who are in a general surgery admission ward. Methods The trial protocol has been published. 50 patients with acute pancreatitis were recruited, consented and randomly allocated to either ward-based GDFT with intravenous (IV) fluids administered based on stroke volume optimisation or standard ward care but with blinded cardiac output evaluation for 48 hours following hospital admission. Results Over a period of 20 months 50 of 142 screened patients were recruited demonstrating that it was feasible to recruit into a randomised trial of this nature in ward patients with acute pancreatitis. 36 (72%) completed the allocated 48 hours of goal directed fluids with 10 (20%) discharged within 48 hours and 4 withdrawals (3 GDFT and 1 SC).  Baseline characteristics of the groups were similar with only 3 participants having severe disease (6%, 1 GDFT, 2 SC). Similar volumes of IV fluids were administered in both groups (GDFT 5465 (1839) ml, SC 5211 (1745) ml). GDFT group had a lower heart rate, blood pressure and respiratory rate and improved oxygen saturations. GDFT was not associated with any harms. Complications of AP appear to be similar as was duration of stay in intensive care. Length of hospital stay was 5 (2.9) in GDFT and 6.3 (7.6) in SC groups. Conclusions Ward GDFT is feasible and shows a signal of possible efficacy in acute pancreatitis in this early-stage study. A larger multi-site RCT is required to confirm clinical and cost effectiveness.

Sign in / Sign up

Export Citation Format

Share Document