International Medical Journal, Vol. 25., Iss. 3, 2019, P. 29−32.
FEATURES OF FLUID REDISTRIBUTION DURING GOAL-DIRECTED INFUSION THERAPY OF HIGH SURGICAL RISK PATIENTS IN URGENT SURGERY
SI "Dnipropertovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, Ukraine
One of the basic components of intensive treatment of patients with an urgent abdominal pathology is perioperative infusion therapy. To analyze the perioperative dynamics of the water sectors of a body in the patients with a high surgical risk with acute abdominal pathology, a targeted regimen of infusion therapy was used to examine 35 patients. Perioperative targeted infusion therapy was carried out with balanced crystalloid solutions. With the non−invasive bioelectric rheography, the indices of water sectors of a body were studied. On the first day, the extracellular sector volume overflow was established due to an increase in interstitial volume. From the second day, the excess volumes of intravascular fluid and plasma were determined. On the third day there was a deficit of all the studied indices. On the fifth day of the post−surgery period, volumetric depletion of mild degree was noted. From the seventh to the tenth days, all the studied parameters to normal were reliably restored. A targeted regimen of infusion therapy in such patients was concluded to correct a moderate volume depletion on the tenth day after surgery by an excessive increase in plasma volume after six hours of treatment, the development of interstitial edema in the first two days, and the formation of mild volumetric depletion from third to seventh day.
Key words: water sectors, goal−direct infusion therapy, depletion, urgent surgery, high surgical risk.
1. Murray D. Improving outcomes following emergency laparotomy / D. Murray // Anaesthesia.− 2014.− Vol. 69.− R. 300−305.
2. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review / C. M. Oliver, E. Walker, S. Giannaris [et al.] // Br. J. of Anaesthesia.− 2015.− Vol. 115 (6).− R. 849−860.
3. Carlisle J. B. Risk prediction models for major surgery: composing a new tune / J. B. Carlisle // Anaesthesia.− 2019.− Vol. 74.− R. 7−12.
4. Vivekanand K. H. Clinical Outcome of Emergency Laparotomy: Our Experience at tertiary care centre (A case series) / K. H. Vivekanand, K. Mohankumar // International J. of Biomedical and Advance Research.− 2015.− Vol. 6 (10).− R. 709−714.
5. Effect of a perioperative, cardiac outputguided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review / R. M. Pearse, D. A. Harrison, N. MacDonald [et al.] // JAMA.− 2014.− Vol. 311.− R. 2181−2190.
6. Perioperative fluid management strategies in major surgery: a stratified meta−analysis / T. Corcoran, J. E. Rhodes, S. Clarke [et al.] // Anesth. Analg.− 2012.− Vol. 114.− R. 640−651.
7. Guidelines for perioperative haemodynamic optimization / B. Vallet, Y. Blanloeil, B. Cholley [et al.] // Ann. Fr. Anesth. Reanim.− 2013.− Vol. 32.− R. 151−158.
8. Update to the high−risk patient released by RCS England. NELA Project Team. Fourth Patient Report of the National Emergency Laparotomy Audit RCoA / Iain Anderson [et al.]; Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme on behalf of NHS England and the Welsh Government, UK.− Produced by the Publications Department Royal College of Anaesthetists, London, 2018.− 135 r.− Dep. 23.08.18, № WC1R 4SG.
9. Intravenous fluid therapy in adults in hospital: clinical guideline CG174.− London: National Institute for Health and Care Excellence, 2017.− URL: https://www.nice.org.uk/guidance/cg174
10. Standarti organіzatsії ta profesіino orієntovanі protokoli nadannya nevіdkladnoї dopomogi khvorim z khіrurgіchnoyu patologієyu organіv zhivota (vіdomcha іnstruktsіya) / Ya. S. Bereznits'kii, V. V. Boiko, M. P. Brusnіtsina [ta іn.]; pod. red. Ya. S. Bereznits'kogo.− Dnіpro: Dnіpro−VAL, 2008.− 256 s.