ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 14 of 49
JMBS 2019, 4(4): 90–94
Clinical Medicine

Hemodynamic Pattern of Restrictive Regimen of Infusion Therapy in High Surgical Risk Patients with Acute Abdominal Pathology

Kravez O. V.

Treatment of the acute abdominal pathology is carried out as a matter of urgency, surgically, and requires correction of fluid disorders. At the same time, there is a constant and significant increase in the number of elderly patients, who are characterized by a concomitant pathology and a decrease in the reserve capacity of the organism. This significantly increases the perioperative risk of adverse events and death, and classifies this category of patients as a high surgical risk group. The purpose of the study was to analyze the state of central and peripheral hemodynamics in restrictive mode of infusion therapy in patients with high surgical risk of acute abdominal pathology. Material and methods. The prospective observational study lasted from January 2016 to December 2018 after approval by the Ethical Commission of the State Institution “Dnipro Medical Academy” of the Ministry of Health Care of Ukraine. We examined 50 patients with acute abdominal pathology with the degree of volume depletion of more than 10% and less than 30%. The patients were operated urgently in the amount of laparotomy. The indices of central and peripheral hemodynamics were determined during 14 days of the postoperative period Results and discussion. At the time of admission, we determined the initial moderately hypodynamic type of blood circulation combined with tachycardia and vasospasm. Perioperative infusion therapy in emergency surgery was primarily aimed at filling the deficit of extracellular fluid and volume depletion, which was accompanied by hemodynamic instability and impaired tissue perfusion. Recovery to the normal stroke volume of the heart, cardiac index, heart rate was determined six hour after the operation. We also noted normal values of the shock index and tissue perfusion. This persisted until the end of the observation. In contrast to the data presented in the RELIEF report, we did not observe the entire perioperative period in patients with disorders of tissue perfusion. Conclusions. The restrictive infusion theraphy regimen in patients with high surgical risk and emergency pathology of the abdominal organs allows correcting volumetric depletion by maintaining the normodynamic type of blood circulation and tissue perfusion throughout the observation period.

Keywords: urgent laparotomy, restrictive regime infusion therapy, central hemodynamic, high surgical risk

Full text: PDF (Rus) 211K

  1. Bereznytskyi YaS, Boyko VV, Brusnitsyna MP, ta in. Standarty orhanizatsiyi ta profesiyno oriyentovani protokoly nadannya nevidkladnoi dopomohy khvorym z khirurhichnoyu patolohiyeyu orhaniv zhyvota (vidomcha instruktsiya). Ed by YaS Bereznytskyi. Dnipro: Dnipro-VAL; 2008. 256 p. [Ukrainian]
  2. 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 р.
  3. Murray D. Improving outcomes following emergency laparotomy. Anaesthesia. 2014; 69: 300-5.
  4. Hoste EA, Maitland KC, Brudney CS, Mehta R, Vincent JL, Yates D, et al. Four phases of intravenous fluid therapy: a conceptual model. British Journal of Anaesthesia. 2014; 113(5): 740-7.
  5. Myles P. Bellomo R, Corcoran T, Forbes A, Wallace S, Peyton P, et al. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trials. BMJ Open. 2017; 7(3): 153-61.
  6. Carlisle JB. Risk prediction models for major surgery: composing a new tune. Anaesthesia. 2019; 74(Suppl 1): 7-12.
  7. Oliver CM, Walker E, Giannaris S, Grocott MPW, Moonesinghe SR. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. BJA: British Journal of Anaesthesia. 2015; 115(6): 849-60.
  8. Klijn E, Marit HN, Lima A, Bakker J, van Bommel J, Groeneveld AB. Tissue perfusion and oxygenation to monitor fluid responsiveness in critically ill, septic patients after initial resuscitation: a prospective observational study. Anaesthesia. 2015; 29: 707–12.
  9. Boland MR, Noorani A, Varty K, Coffey JC, Agha R, Walsh SR. Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, clinical trials. World J Surg. 2013; 37: 1193-202.
  10. Intravenous fluid therapy in adults in hospital: clinical guideline CG174. London: National Institute for Health and Care Excellence, 2017. Available from: https://www.nice
  11. Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012; 114: 640-51.
  12. Zhu ACC, Agarwala A, Bao X. Perioperative Fluid Management in the Enhanced Recovery after Surgery (ERAS). Clinics in Colon and Rectal Surgery. 2019; 32(02): 114-20.