Fluid challenges in operating room: A planned sub study of the Fluid Day observational study

J Ripollés-Melchor; C Aldecóa; J V Lorente; A Ruiz-Escobar; M I Monge-García; I Jiménez; J L Jover-Pinillos; P Galán-Menendez; J L Tomé-Roca; P Fernández-Valdes-Balgo; M J Colomina; Fluid Day Investigators Group

doi:10.1016/j.redare.2022.03.004

Fluid challenges in operating room: A planned sub study of the Fluid Day observational study

Rev Esp Anestesiol Reanim (Engl Ed). 2023 Jun-Jul;70(6):311-318. doi: 10.1016/j.redare.2022.03.004. Epub 2023 Jun 3.

Affiliations

¹ Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain. Electronic address: ripo542@gmail.com.
² Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesiology and Surgical Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain.
³ Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia and Critical Care, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
⁴ Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain.
⁵ Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Edwards Lifesciences, Irvine, California, United States.
⁶ Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
⁷ Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Verge dels Lliris, Alcoy, Alicante, Spain.
⁸ Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Vall d'Hebrón, Barcelona, Spain.
⁹ Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Virgen de las Nieves, Granada, Spain.
¹⁰ Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia and Critical Care, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.

PMID: 37276966
DOI: 10.1016/j.redare.2022.03.004

Abstract

Background: Intraoperative fluid administration is a ubiquitous intervention in surgical patients. But inadequate fluid administration may lead to poor postoperative outcomes. Fluid challenges (FCs), in or outside the so-called goal-directed fluid therapy, allows testing the cardiovascular system and the need for further fluid administration. Our primary aim was to evaluate how anesthesiologists conduct FCs in the operating room in terms of type, volume, variables used to trigger a FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.

Methods: This was a planned substudy of an observational study conducted in 131 centres in Spain in patients undergoing surgery.

Results: A total of 396 patients were enrolled and analysed in the study. The median [interquartile range] amount of fluid given during a FC was 250ml (200-400). The main indication for FC was a decrease in systolic arterial pressure in 246 cases (62.2%). The second was a decrease in mean arterial pressure (54.4%). Cardiac output was used in 30 patients (7.58%), while stroke volume variation in 29 of 385 cases (7.32%). The response to the initial FC did not have an impact when prescribing further fluid administration.

Conclusions: The current indication and evaluation of FC in surgical patients is highly variable. Prediction of fluid responsiveness is not routinely used, and inappropriate variables are frequently evaluated for assessing the hemodynamic response to FC, which may result in deleterious effects.

Keywords: Clínicos; Cohort studies; Estudios de cohortes; Fluid therapy; Fluidoterapia; Patrones de prácticas; Physicians; Practice patterns.

Publication types

Observational Study

MeSH terms

Cardiac Output
Fluid Therapy*
Hemodynamics
Humans
Operating Rooms*
Stroke Volume / physiology