Intravenous fluid and electrolyte administration in elective gastrointestinal surgery: mechanisms of excessive therapy

INTRODUCTION While clinical guidelines stress the importance of the judicious perioperative intravenous fluid administration, data show that adherence to these protocols is poor. The reasons have not been identified. We therefore audited the magnitude and indications of fluid and electrolyte administration in a teaching hospital. We hypothesised that epidural analgesia is associated with excessive fluid therapy. MATERIALS AND METHODS Intravenous fluid and electrolyte administration during the day of surgery and the subsequent 2 days in consecutive patients undergoing elective gastrointestinal surgery between November 2013 and May 2014 were retrospectively audited. Timing, volumes and indications were recorded. RESULTS One hundred patients undergoing elective gastrointestinal resection were studied. Patients received 9030 ml ± 2860 ml (mean ± standard deviation) intravenous fluids containing a total of 1180 ml ± 420 mmol sodium and resulting in a cumulative fluid balance of +5120 ml ± 2510 ml; 44% ± 14% of total volumes were given in theatre. Nearly all fluid was given for maintenance, 100% (96–100%, interquartile range), with 17 patients only receiving replacement or resuscitation. Independent predictors of increased volumes included open surgery, upper gastrointestinal surgery, increased duration and epidural analgesia but not body weight. Postoperative fluid volume was the only independent predictor of postoperative complication grade (P = 0.0044). CONCLUSIONS Despite published guidelines, perioperative fluid and electrolyte administration were excessive and were associated with postoperative morbidity. Substantial volumes were administered in theatre. Nearly all administration was for maintenance, yet patients received approximately five times the amount of sodium required. Epidural analgesia was an independent predictor of fluid volumes but body weight was not.

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Enterobacter Sepsis in Infants and Children Due to Contaminated Intravenous Fluids

Infection Control ◽

10.1017/s0195941700060872 ◽

1984 ◽

Vol 5 (10) ◽

pp. 471-477 ◽

Cited By ~ 40

Author(s):

Nikos S. Matsaniotis ◽

Vassiliki Ph. Syriopoulou ◽

Maria Ch. Theodoridou ◽

Konstantina G. Tzanetou ◽

Glyceria I. Mostrou

Keyword(s):

Bacterial Contamination ◽

Blood Stream ◽

Intravenous Fluid ◽

Intravenous Fluids ◽

Pediatric Hospital ◽

Enterobacter Agglomerans ◽

Nosocomial Sepsis ◽

Nosocomial Bacteremia ◽

Intravenous Fluid Administration ◽

Laboratory Investigations

AbstractSixty-three cases of nosocomial sepsis occurring from April through October 1981, in a 500-bed pediatric hospital, were traced to bacterial contamination of intravenous fluid produced by a single manufacturer. Two species of uncommon blood stream pathogens, Enterobacter cloacae and Enterobacter agglomerans contaminated the fluid. Infections with these organisms might have contributed to the death of four patients; two who were immunosuppressed, one who was asplenic and one premature infant. Epidemiologic and laboratory investigations identified the site of contamination to be within the screw-caps of the bottles containing the intravenous fluid. Contamination occurred during insertion of the intravenous fluid administration set into the bottle. The “epidemic” terminated when the hospital discontinued the use of infusion fluids from that manufacturer. We conclude that intravenous fluids should be examined during outbreaks of nosocomial bacteremia due to unusual pathogens.

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Comparative Clinical Effects of Early Pharyngostomy Alimentation and Intravenous Fluid Infusion following Oesophageal Transection and Anastomosis in Nigerian Breeds of Dogs

Nigerian Veterinary Journal ◽

10.4314/nvj.v41i3.6 ◽

2021 ◽

Vol 41 (3) ◽

pp. 256-263

Author(s):

J.O Omamegbe ◽

U.N Njoku ◽

S.E Ibup

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Recovery Period ◽

Intravenous Fluid ◽

Intravenous Fluids ◽

Clinical Effects ◽

Fluid Infusion ◽

Dog Food ◽

Cervical Swelling ◽

Clinical Responses

Twelve adult Nigerian breeds of dogs were used to compare the clinical responses of dogs alimented through pharyngostomy tubes (PGTs) with those maintained on intravenous infusion (50:50 mixture of Ringers lactate and 5% dextrose saline) during the first 14 days following oesophageal transection and anastomosis (OTA). The dogs were assigned to two groups (n=6), the pharyngostomy tube (PGT) group and the intravenous fluid infusion (IVF) group (n=6). Dogs in both groups underwent routine OTA. The PGT group was fed blanched processed dog food at 70g/kg body weight for 14 days through PGTs, while the IVF group was maintained on intravenous fluids at a dose of 70 mL/kg body weight daily also for 14 days post operatively. The postoperative complications observed in both groups showed that the mortality rate in the IVF group (83.3%) was significantly (P < 0.05) higher than in the PGT group (16.7%). Vomiting and leakages at the site of oesophageal anastomosis did not differ significantly between the groups. Cervical swelling was observed in two dogs (33.3%) in the IVF group, while tenesmus and displacement of the tubes were recorded in 66.6% and 100% respectively of the dogs in the PGT group. It is concluded that feeding dogs which had undergone OTA through PGTs during the immediate postoperative period reduces their morbidity and mortality; and shortens the recovery period when compared with similar dogs maintained solely on intravenous fluids. Keywords: Oesophageal, Transection, Anastomosis, Pharyngostomy, Complications, Morbidity, Mortality.

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EP.TH.174The FLIP Study – Fluid Resuscitation in Pancreatitis

British Journal of Surgery ◽

10.1093/bjs/znab309.025 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Julia McGovern ◽

John Moir ◽

Sam Tingle ◽

Emma Hawthornwaite ◽

Stuart Robinson ◽

...

Keyword(s):

Acute Pancreatitis ◽

Data Collection ◽

Observational Studies ◽

Statistical Significance ◽

Fluid Administration ◽

Intravenous Fluid ◽

P Value ◽

Intravenous Fluids ◽

North East ◽

Intravenous Fluid Administration

Abstract Acute pancreatitis is a common condition encountered in emergency general surgical presentations. The severity of this condition can range from mild to severe and potentially life threatening in up to 20% of cases. Intravenous fluids are the cornerstone of management however there is very little guidance and poor quality evidence regarding optimal intravenous fluid administration. Aim to establish current clinical practice regarding the rate of intravenous fluid administration in acute pancreatitis and the effect this has on patient morbidity and mortality. A prospective multi-centre audit of patients presenting with acute pancreatitis in the North East of England (Sixty days recruitment with 30-day follow-up, November 2020 – February 2021). Patients aged 18 years or above with acute pancreatitis will be included. Data will be collected on intravenous fluid administration within 72 hours of admission. The primary outcome measure will be admission to HDU/ITU with secondary end-points including 30-day mortality, length of stay, radiological evidence of necrosis, and evidence of organ failure. Data collection has commenced across nine sites with over 150 patients recruited to date. The results of this study will be prepared in accordance with guidelines set by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Data will be analysed using SPSS. Statistical significance will be defined as a p value of ≤ 0.05. Data collection will be completed in February 2021. Pending the results of phase one, an RCT will be designed to determine the optimal rate of intravenous fluids for improved patient outcomes.

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P126 The FLIP study – Fluid resuscitation In Pancreatitis

BJS Open ◽

10.1093/bjsopen/zrab032.125 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

John Moir ◽

Sam Tingle ◽

Emma Hawthornthwaite ◽

Stuart Robinson ◽

Jeremy French ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Studies ◽

Statistical Tests ◽

Statistical Significance ◽

Fluid Administration ◽

Intravenous Fluid ◽

P Value ◽

Intravenous Fluids ◽

North East ◽

Intravenous Fluid Administration

Abstract Introduction Acute pancreatitis is a common condition encountered in emergency general surgical presentations. The severity of this condition can range from mild, whereby symptoms settle with simple conservative measures, to severe and potentially life threatening in up to 20% of cases. Intravenous fluids are the cornerstone of management in these patients, however there is very little guidance and poor quality evidence within the research literature regarding optimal intravenous fluid administration. The aim of this study is to establish current clinical practice within the North East of England regarding the rate of intravenous fluid administration in acute pancreatitis and the effect this has on patient morbidity and mortality. Methods This project is a prospective multi-centre snapshot audit of patients presenting with acute pancreatitis over a one month period, with 30 days follow up. Inclusion criteria are patients aged 18 or above with acute pancreatitis. Data will be collected on intravenous fluid administration in the first 72 hrs following admission in addition to demographics and severity scoring. The primary outcome measure will be admission to HDU/ITU with key secondary end-points including 30-day mortality, length of stay, radiological evidence of pancreatic necrosis and evidence of organ failure. Results The results of this study will be prepared in accordance with guidelines set by the STROBE: (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Data will be collected and analysed with appropriate statistical tests using SPSS. Statistical significance will be defined as a p value of ≤ 0.05 Conclusion Data collection will be completed in early 2021 with analysis and write up planned for early in the new year. Pending the results of phase one, an RCT will be designed to determine the optimal rate of intravenous fluids for improved patient outcome.

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Intravenous Fluid Use in an Indonesian Community Cohort 0-18 Months of Age

10.21203/rs.3.rs-140816/v1 ◽

2021 ◽

Author(s):

Jarir At Thobari ◽

Cahya Satria ◽

Kevin Johanes ◽

Jonathan Hasian Haposan ◽

Emma Watts ◽

...

Keyword(s):

Adverse Events ◽

Controlled Trial ◽

Fluid Management ◽

Healthcare Providers ◽

Intravenous Fluid ◽

Trial Registration ◽

Intravenous Fluids ◽

Intravenous Fluid Administration ◽

Use Pattern

Abstract Background Intravenous fluid administration is one of the most common and important life-saving treatments in daily clinical settings, however it is not given as much attention as it should have. This study aims to evaluate the intravenous fluid’s use pattern in infants from birth until 18 months of age in Indonesia. Methods A post-hoc analysis of RV3-BB Phase IIb randomized, double-blinded, placebo-controlled trial was conducted in 1621 participants in Indonesia between January 2013 and July 2016. Any health events were documented in the trial as adverse events. Concomitant medication surveillance recorded all medications, including intravenous fluids (IVF) during the 18 months of follow-up. Information included intravenous fluid type, methods of administration, dosage, indication and duration. Results Of 1621 participants, 251 (15.48%) participants received at least one intravenous fluid for treating 294 adverse events during their 18-month follow-up period. A total of 333 intravenous fluid consumptions were recorded, 20 (6.0%) as fluid resuscitation, 273 (81.98%) as fluid maintenance, 40 (12.01%) as both maintenance and resuscitation. Isotonic fluids predominated resuscitation fluids (52 out of 60 [86.7%]) and maintenance fluids (166 out of 313 [53.0%]). Hyponatremia (1 case) was detected among those administered with hypotonic fluids (143 out 313 [45.7%] IVFs) for maintenance fluid. The most common indication for intravenous fluid was gastroenteritis (31.6%), with dehydration in most cases (65 [69.9%]). Modified WHO’s plan B diarrhea management was recorded in 22 [23.7%] diarrhea cases. Conclusions This study provides the information of intravenous fluid use pattern in 0–18 months children cohort in Indonesia. Some intravenous fluids were found to be unnecessary and not optimal, exposing the patients to the avoidable risks. These data justify the further study to evaluate intravenous fluid use in children and the needs of continuing training on intravenous fluid management among healthcare providers. Trial registration: Trial registration: ACTRN12612001282875, Registered: 12/12/2012, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612001282875

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