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Der Anaesthesist Feb 2021Intravascular fluid administration belongs to the cornerstones of perioperative treatment with a substantial impact on surgical outcome especially with respect to major... (Review)
Review
Intravascular fluid administration belongs to the cornerstones of perioperative treatment with a substantial impact on surgical outcome especially with respect to major abdominal surgery. By avoidance of hypovolemia and hypervolemia, adequate perioperative fluid management significantly contributes to the reduction of insufficient tissue perfusion as a determinant of postoperative morbidity and mortality. The effective use of intravascular fluids requires detailed knowledge of the substances as well as measures to guide fluid therapy. Fluid management already starts preoperatively and should be continued in the postoperative setting (recovery room, peripheral ward) considering a patient-adjusted and surgery-adjusted hemodynamic monitoring. Communication between all team members participating in perioperative care is essential to optimize fluid management.
Topics: Abdomen; Fluid Therapy; Hemodynamic Monitoring; Humans; Hypovolemia; Perioperative Care
PubMed: 33034685
DOI: 10.1007/s00101-020-00867-7 -
Saudi Medical Journal Feb 2017To determine whether perioperative fluid restrictive administration can reduce specific postoperative complications in adults undergoing major abdominal... (Review)
Review
To determine whether perioperative fluid restrictive administration can reduce specific postoperative complications in adults undergoing major abdominal surgery. Methods: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, Google scholar, and article reference lists (up to December 2015) for studies that assessed fluid therapy and morbidity or mortality in patients undergoing major abdominal surgeries. The quality of the trials was assessed using the Jadad scoring system, and a meta-analysis of the included randomized, controlled trials was conducted using Review Manager software, version 5.2. Results: Ten studies with a total of 1160 patients undergoing major abdominal surgeries were included. We found that perioperative restrictive fluid therapy could reduce the risk of postoperative infectious complications (odds ratio [OR]=0.54, 95% confidence interval [CI]: 0.39-0.74, p=0.0001, I2=37%), pulmonary complications (OR=0.49, 95% CI: 0.26-0.93, p=0.03, I2=50%), and cardiac complications (OR=0.45, 95% CI: 0.29-0.69, p=0.0003, I2=48%), but had no effect on the risk of gastrointestinal complications (OR=0.87, 95% CI: 0.51-1.46, p=0.59, I2=0%), renal complications (OR=0.76, 95% CI: 0.43-1.34, p=0.35, I2=0%), and postoperative mortality (OR=0.62, 95% CI: 0.25-1.50, p=0.29, I2=0%). Conclusion: Perioperative restrictive fluid administration was superior to liberal fluid administration in reducing the infectious, pulmonary and cardiac complications after major abdominal surgeries.
Topics: Abdomen; Drinking; Fluid Therapy; Humans; Perioperative Period; Postoperative Complications
PubMed: 28133683
DOI: 10.15537/smj.2017.2.15077 -
Anesthesiology Clinics Mar 2015The entire team (including anesthesiologists, surgeons, and intensive care physicians) must work together (before, during, and after abdominal surgery) to determine the... (Review)
Review
The entire team (including anesthesiologists, surgeons, and intensive care physicians) must work together (before, during, and after abdominal surgery) to determine the optimal amount (quantity) and type (quality) of fluid necessary in the perioperative period. The authors present an overview of the basic principles that underlie fluid management, including evidence-based recommendations (where tenable) and a rational approach for when and what to administer.
Topics: Abdomen; Administration, Intravenous; Colloids; Crystalloid Solutions; Fluid Therapy; Humans; Isotonic Solutions; Perioperative Care
PubMed: 25701928
DOI: 10.1016/j.anclin.2014.11.004 -
Child's Nervous System : ChNS :... Apr 2014Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with ventriculoperitoneal shunt (VPS). In addition to presenting our... (Comparative Study)
Comparative Study Review
PURPOSE
Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with ventriculoperitoneal shunt (VPS). In addition to presenting our experience, we performed a comparative analysis between children and adults with this entity. To the author's knowledge, there are no studies in which this condition has been compared.
METHODS
The PubMed database was searched for all relevant reports published from 1954 to 2012. The differences were statistically compared, especially regarding clinical investigations, etiology of the hydrocephalus, shunt revision, CSF infection, treatment, and recurrence. Chi-square test or Fisher's exact test was used to find associations among the variables.
RESULTS
Compiled from literature, we found 393 cases of abdominal pseudocyst: 295 children, including our cases, and 55 adults, with age not informed in 43 cases. In children, 33 % of the patients have a positive culture on presentation, with higher incidence in children younger than 10 years. In contrast, only 15 % among adults were positive CSF culture. In total, 287 abdominal pseudocyst cases who underwent shunt revision have been reported; 78.4 % of children and 62.2 % of adults. The main occurrence of this complication according to the etiology of hydrocephalus in children was different from adults. The recurrence of pseudocyst occurred in 19.8 and 24.2 % of children and adults, respectively.
CONCLUSIONS
The differences between children and adults might represent distinct trends on the etiology and treatment of this entity. Hence, additional well-designed cohort studies will be necessary to strengthen our findings.
Topics: Abdomen; Adult; Cerebrospinal Fluid; Child; Cysts; Humans; Hydrocephalus; Ventriculoperitoneal Shunt
PubMed: 24469949
DOI: 10.1007/s00381-014-2370-2 -
Current Opinion in Critical Care Dec 2021The aim of this study was to outline the management of the patient with the open abdomen. (Review)
Review
PURPOSE OF REVIEW
The aim of this study was to outline the management of the patient with the open abdomen.
RECENT FINDINGS
An open abdomen approach is used after damage control laparotomy, to decrease risk for postsurgery intra-abdominal hypertension, if reoperation is likely and after primary abdominal decompression.Temporary abdominal wall closure without negative pressure is associated with higher rates of intra-abdominal infection and evisceration. Negative pressure systems improve fascial closure rates but increase fistula formation. Definitive abdominal wall closure should be considered once oedema has subsided and the patient has stabilized. Delayed abdominal closure after trauma (>24-48 h) is associated with less achievement of fascial closure and more complications. Protective lung ventilation should be employed early, particularly if respiratory compromise is evident. Conservative fluid management and less sedation may decrease delirium and increase definitive abdominal closure rates. Extubation may be performed before definitive abdominal closure in selected patients. Antibiotic therapy should be brief, targeted and guideline concordant. Survival depends on the underlying disease, the closure method and the course of hospitalization.
SUMMARY
Changes in the treatment of patients with the open abdomen include negative temporary closure, conservative fluid management, early protective lung ventilation, decreased sedation and extubation before abdominal closure in selected patients.
Topics: Abdomen; Abdominal Cavity; Abdominal Injuries; Humans; Intra-Abdominal Hypertension; Laparotomy; Retrospective Studies
PubMed: 34561356
DOI: 10.1097/MCC.0000000000000879 -
Der Radiologe Nov 2018Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge... (Review)
Review
BACKGROUND
Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed.
RESULTS
The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septa.
CONCLUSION
In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).
Topics: Abdomen; Child, Preschool; Cysts; Diagnosis, Differential; Humans; Lymphatic Abnormalities; Ultrasonography; Young Adult
PubMed: 29796772
DOI: 10.1007/s00117-017-0337-5 -
Veterinary Journal (London, England :... Apr 2011The aim of this prospective study was to establish a protocol for fast localised abdominal sonography of horses (FLASH) admitted for colic. The FLASH protocol was then...
The aim of this prospective study was to establish a protocol for fast localised abdominal sonography of horses (FLASH) admitted for colic. The FLASH protocol was then presented to clinicians without extensive ultrasound (US) experience to determine whether they could learn to use it in less than 15 min. The clinical subjects comprised 36 horses that had been referred for colic over a 2 month period. Each horse was examined at admission and FLASH findings at seven topographical locations were compared to serial clinical examinations, surgical and non-surgical outcomes, or with post-mortem reports. FLASH was able to show free abdominal fluid and abnormal intestinal loops, with a mean time of 10.7 min required to complete the protocol. The positive and negative predictive values of requirement for surgery of dilated turgid small intestinal loops using FLASH were 88.89% and 81.48%, respectively. The results suggested that FLASH is a technique that can be used in an emergency setting by veterinarians without extensive US experience to detect major intra-abdominal abnormalities in horses with colic.
Topics: Abdomen; Animals; Ascitic Fluid; Colic; Female; Horse Diseases; Horses; Intestine, Small; Male; Predictive Value of Tests; Prospective Studies; Ultrasonography
PubMed: 20347357
DOI: 10.1016/j.tvjl.2010.02.017 -
World Journal of Surgery Jun 2013Fluid management is a fundamental component of surgical care. Recently, there has been considerable interest in perioperative fluid restriction as a method of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fluid management is a fundamental component of surgical care. Recently, there has been considerable interest in perioperative fluid restriction as a method of facilitating recovery following elective major surgery. A number of randomized trials have addressed the issue in various surgical specialities, and a recent meta-analysis proposed uniform definitions regarding fluid amount as well as examining fluid restriction in patients undergoing colonic resection.
METHODS
Medline, Embase, trial registries, conference proceedings, and article reference lists were searched to identify randomized, controlled trials of perioperative fluid restriction versus "standard" perioperative fluid management, as per definitions formulated previously. All of the studies involved patients undergoing colonic resection. The primary outcome measure was postoperative morbidity. Secondary endpoints included mortality, renal failure, time to first flatus, and length of hospital stay. A random effects model was applied.
RESULTS
Seven randomized, controlled trials with a total of 856 patients investigating standard versus restrictive fluid regimes, as denoted by the definitions, were included. Perioperative fluid restriction had no effect on the risk of postoperative complications (OR 0.49 (95 % confidence interval (CI) 0.2-1.18; P = 0.101). There was no detectable effect on death and fluid restriction did not reduce hospital stay (Pooled weighted mean difference -0.25; 95 % CI 0.72-0.21; P = 0.29).
CONCLUSIONS
Perioperative fluid restriction does not significantly reduce the risk of complications following major abdominal surgery. Furthermore, it does not appear to reduce length of hospital stay.
Topics: Abdomen; Elective Surgical Procedures; Fluid Therapy; Humans; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 23463399
DOI: 10.1007/s00268-013-1987-8 -
World Journal of Surgery Nov 2019Perioperative fluid management is a critical component in patients undergoing abdominal surgery. However, the benefit of restricted fluid regimen remains inconclusive.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Perioperative fluid management is a critical component in patients undergoing abdominal surgery. However, the benefit of restricted fluid regimen remains inconclusive. This systematic review aimed to explore potential factors causing these inconsistent findings.
METHODS
The literature searches were performed in three databases including PubMed, Embase, and the Cochrane library until August 30, 2018. Only randomized, controlled trials comparing the effect of restricted versus liberal regimen in abdominal surgery were included. The primary outcome was total postoperative complications. Subgroup analysis was performed according to between-group weight increase difference (≥ 2 kg and < 2 kg) and fluid intake ratio (≥ 1.8 and < 1.8).
RESULTS
Sixteen studies were finally included in this meta-analysis. The benefit of the restricted regimen in reducing postoperative complication was only significant in the subgroup with high weight increase difference (≥ 2 kg) (RR 0.67, 95% CI 0.57-0.79) and the subgroup with high fluid intake ratio (≥ 1.8) (RR 0.72, 95% CI 0.62-0.82). In the subgroup with low weight increase difference (< 2 kg) or low fluid intake ratio (< 1.8), the effect of the restricted regimen was not significant (RR 0.88, 95% CI 0.51-1.50, and RR 1.18, 95% CI 0.91-1.53, respectively).
CONCLUSIONS
The benefit of the restricted regimen was only significant in the subgroup with high weight increase difference (≥ 2 kg) or high fluid intake ratio (≥ 1.8).
Topics: Abdomen; Fluid Therapy; Humans; Perioperative Care; Postoperative Complications
PubMed: 31332489
DOI: 10.1007/s00268-019-05091-y -
Scientific Reports Jan 2022A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Our objective was to evaluate... (Observational Study)
Observational Study
A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Our objective was to evaluate the appearance of B-lines as a diagnostic marker of preload unresponsiveness and postoperative complications in the operating theater. We conducted a prospective, bicentric, observational study. Adult patients undergoing abdominal surgery were included. Stroke volume (SV) was determined before and after a fluid challenge with 250 mL crystalloids (Delta-SV) using esophageal Doppler monitoring. Responders were defined by an increase of Delta-SV > 10% after fluid challenge. B-lines were collected at four bilateral predefined zones (right and left anterior and lateral). Delta-B-line was defined as the number of newly appearing B-lines after a fluid challenge. Postoperative pulmonary complications were prospectively recorded according to European guidelines. In total, 197 patients were analyzed. After a first fluid challenge, 67% of patients were responders and 33% were non-responders. Delta-B-line was significantly higher in non-responders than responders [4 (2-7) vs 1 (0-3), p < 0.0001]. Delta-B-line was able to diagnose fluid non-responders with an area under the curve of 0.74 (95% CI 0.67-0.80, p < 0.0001). The best threshold was two B-lines with a sensitivity of 80% and a specificity of 57%. The final Delta-B-line could predict postoperative pulmonary complications with an area under the curve of 0.74 (95% CI 0.67-0.80, p = 0.0004). Delta-B-line of two or more detected in four lung ultrasound zones can be considered to be a marker of preload unresponsiveness after a fluid challenge in abdominal surgery.The objectives and procedures of the study were registered at Clinicaltrials.gov (NCT03502460; Principal investigator: Stéphane BAR, date of registration: April 18, 2018).
Topics: Abdomen; Aged; Female; Humans; Male; Middle Aged; Prospective Studies; Ultrasonography
PubMed: 35079044
DOI: 10.1038/s41598-022-05251-6