• Humans
• Surgical Wound Infection/prevention & control
• Homeostasis/physiology
• Perioperative Care/methods
• Perioperative Care/standards
• Practice Guidelines as Topic/standards
• Perioperative Period/standards

• Colorectal neoplasms
• Enhanced Recovery After Surgery
• Practice guideline

• NCC-2112570-4 National Cancer Center

• Anesthesia management
• Complications
• Gastrointestinal surgery
• Intraoperative goal-directed fluid therapy
• Length of stay
• Postoperative recovery

• Atrial Fibrilation
• Cardiac Conduction System Disease
• Control Groups
• Delirium
• Fluid Therapy
• Incidence
• Ischemia
• Stroke Volume
• Transcatheter Aortic Valve Replacemnet

• Humans
• Adolescent
• Transcatheter Aortic Valve Replacement/adverse effects
• Retrospective Studies
• Prospective Studies
• Feasibility Studies
• Goals
• Delirium/etiology
• Delirium/surgery
• Fluid Therapy/methods
• Aortic Valve Stenosis/surgery
• Aortic Valve/surgery
• Treatment Outcome
• Risk Factors
• Length of Stay

• continuous cardiac output monitoring
• general anaesthesia
• goal-directed fluid therapy
• intraoperative fluid therapy
• network meta-analysis
• perioperative fluid management
• systematic literature review

• Colorectal
• ERAS
• goal-directed fluid therapy
• ileus
• length of stay
• mortality

• enhanced recovery after surgery
• goal-directed fluid therapy
• haemodynamic monitoring
• intraoperative fluid management
• laparoscopic abdominal surgery
• perioperative care

• GINOP-2.3.2-15-2016-00048 - STAY ALIVE Economic Development and Innovation Operational Programme Grant
• K 138816 Hungarian National Research, Development and Innovation Office

• fluid
• general anaesthesia
• goal-directed haemodynamic therapy
• haemodynamics
• perioperative care
• postoperative complications
• stroke volume

• Anesthesia, General/mortality
• General Surgery/methods
• Hemodynamics/physiology
• Humans
• Postoperative Complications/mortality
• Postoperative Complications/prevention & control

About 50% patients who underwent off-pump coronary artery bypass grafting (OPCAB) experienced perioperative hypothermia. Pre-warming and intraoperative infusion of amino acid injection are the most popular perioperative insulation measures in recent years, but neither of them can completely prevent intraoperative hypothermia. The objective is to investigate the effect of preoperative warming and/or intraoperative infusion of amino acid injection on body temperature in patients undergoing OPCAB.

A prospective, double blind, randomized controlled, single-center study. Seventy-two patients were randomly divided into 4 groups: control group, pre-warming group, amino-acid group and multi-mode group. Pre-warming and multi-mode group were pre-heated with warming blankets and forced-air warming system before induction. After that, amino-acid and multi-mode group were infused with 18-amino acid solution. The perioperative temperature and complications were monitored.

The temperature of control and amino-acid group decreased significantly, but amino-acid group recovered to preoperative level faster. The temperature of pre-warming group was stable, and that in multi-mode group increased at 60 min after the start of surgery. There was a significant difference in temperature at each time, and no difference in the incidence of complications between the groups.

Preoperative warming and/or intraoperative infusion of amino acid injection can effectively reduce hypothermia in OPCAB surgery. Pre-warming before anesthesia is more effective, and the combination of the two methods has the best effect.

• Perioperative hypothermia
• amino acid therapy
• off-pump coronary artery bypass grafting (OPCAB)
• pre-warming

Perioperative goal-directed haemodynamic therapy (GDHT), defined as the administration of fluids with or without inotropes or vasoactive agents against explicit measured goals to augment blood flow, has been evaluated in many randomised controlled trials (RCTs) over the past four decades. Reported post-operative pulmonary complications commonly include chest infection or pneumonia, atelectasis, acute respiratory distress syndrome or acute lung injury, aspiration pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the substantial clinical literature in this area, it remains unclear whether their incidence is reduced by GDHT. This systematic review aims to determine the effect of GDHT on the respiratory outcomes listed above, in surgical patients.

We searched the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical trial registries up until January 2020. We included all RCTs reporting pulmonary outcomes. The primary outcome was post-operative pulmonary complications and secondary outcomes were specific pulmonary complications and intra-operative fluid input. Data synthesis was performed on Review Manager and heterogeneity was assessed using I² statistics.

We identified 66 studies with 9548 participants reporting pulmonary complications. GDHT resulted in a significant reduction in total pulmonary complications (OR 0.74, 95% CI 0.59 to 0.92). The incidence of pulmonary infections, reported in 45 studies with 6969 participants, was significantly lower in the GDHT group (OR 0.72, CI 0.60 to 0.86). Pulmonary oedema was recorded in 23 studies with 3205 participants and was less common in the GDHT group (OR 0.47, CI 0.30 to 0.73). There were no differences in the incidences of pulmonary embolism or acute respiratory distress syndrome. Sub-group analyses demonstrated: (i) benefit from GDHT in general/abdominal/mixed and cardiothoracic surgery but not in orthopaedic or vascular surgery; and (ii) benefit from fluids with inotropes and/or vasopressors in combination but not from fluids alone. Overall, the GDHT group received more colloid (+280 ml) and less crystalloid (−375 ml) solutions than the control group. Due to clinical and statistical heterogeneity, we downgraded this evidence to moderate.

This systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate.

PROSPERO registry reference: CRD42020170361

• Fluid therapy
• Goal-directed
• Surgery

Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. Since the most suitable type of fluid is debatable, a consensus in perioperative patients has not been reached.

We performed a systematic review of randomized control trials (RCTs) that compared two or more types of fluids in major abdominal surgery. The outcomes were related to bleeding, hemodynamic status, length of hospital stay, and complications, such as kidney injury, electrolyte abnormality, major cardiac adverse event, nausea, vomiting, and mortality. A literature search was performed using Medline and EMBASE up to December 2019. The data were pooled to investigate the effect of fluid on macrocirculation and intravascular volume effect.

Forty-three RCTs were included. Eighteen fluids were compared: nine were crystalloids and nine were colloids. The results were categorized into macrocirculation and intravascular volume effect, microcirculation, anti-inflammatory parameters, vascular permeability, renal function (colloids), renal function and electrolytes (crystalloids), coagulation and bleeding, return of bowel function, and postoperative nausea vomiting (PONV). We found that no specific type of fluid led to mortality and every type of colloid was equivalent in volume expansion and did not cause kidney injury. However, hydroxyethyl starch and dextran may lead to increased bleeding. Normal saline can cause kidney injury which can lead to renal replacement therapy, and dextrose fluid can decrease PONV.

In our opinion, it is safe to give a balanced crystalloid as the maintenance fluid and give a colloid, such as HES130/0.4, 4% gelatin, or human albumin, as a volume expander.

• Abdominal surgery
• Colloids
• Crystalloids
• Fluid strategy
• Postoperative complications
• Volume replacement

Gastrointestinal dysfunction (GDF) is one of the primary causes of morbidity and mortality in critically ill patients. Intensive care interventions, such as intravenous fluids and enteral feeding, can exacerbate GDF. There exists a paucity of high-quality literature on the interaction between these two modalities (intravenous fluids and enteral feeding) as a combined therapy on its impact on GDF.

To review the impact of intravenous fluids and enteral nutrition individually on determinants of gut function and implications in clinical practice.

Randomized controlled trials on intravenous fluids and enteral feeding on GDF were identified by a comprehensive database search of MEDLINE and EMBASE. Extraction of data was conducted for study characteristics, provision of fluids or feeding in both groups and quality of studies was assessed using the Cochrane criteria. A random-effects model was applied to estimate the impact of these interventions across the spectrum of GDF severity.

Restricted/ goal-directed intravenous fluid therapy is likely to reduce ‘mild’ GDF such as vomiting (p = 0.03) compared to a standard/ liberal intravenous fluid regime. Enterally fed patients experienced increased episodes of vomiting (p = <0.01) but were less likely to develop an anastomotic leak (p = 0.03) and peritonitis (p = 0.03) compared to parenterally fed patients. Vomiting (p = <0.01) and anastomotic leak (p = 0.04) were significantly lower in the early enteral feeding group.

There is less emphasis on the combined approach of intravenous fluid resuscitation and enteral feeding in critically ill patients. Conservative fluid resuscitation and aggressive enteral feeding are presumably key factors contributing to severe life-threatening GDF. Future trials should evaluate the impact of cross-interaction between conservative and aggressive modes of these two interventions on the severity of GDF.

• critical illness
• enteral feeding
• gastrointestinal dysfunction
• gastrointestinal failure
• intravenous fluids
• resuscitation
• surgical

• Colorectal Surgery/instrumentation
• Colorectal Surgery/methods
• Colorectal Surgery/mortality
• Echocardiography, Transesophageal/methods
• Elective Surgical Procedures/adverse effects
• Elective Surgical Procedures/methods
• Fluid Therapy/methods
• Goals
• Humans
• Length of Stay/statistics & numerical data
• Monitoring, Intraoperative/instrumentation
• Mortality/trends
• Perioperative Period
• Postoperative Complications/epidemiology
• Randomized Controlled Trials as Topic
• Treatment Outcome
• Ultrasonography, Doppler/methods

• 19891 Versus Arthritis
• MR/K00414X/1 Medical Research Council
• MR/P021220/1 Medical Research Council
• 19891 Arthritis Research UK

Perioperative fluid overload is an important modifiable risk factor for adverse outcomes after colorectal surgery. This study aimed to define critical thresholds for perioperative fluid management and postoperative weight gain for patients undergoing elective laparoscopic colorectal surgery.

This was an analysis of consecutive elective laparoscopic colorectal resections at Lausanne University Hospital from May 2011 to May 2017. Main outcomes were overall, major (Clavien–Dindo grade IIIb or above) and respiratory complications, and postoperative ileus. Thresholds regarding perioperative fluid management and postoperative weight gain were identified through receiver operating characteristic (ROC) analysis and clinical judgement. Independent risk factors for all four outcomes were assessed by multinominal logistic regression.

Overall and major complications occurred in 210 (36·2 per cent) and 46 (7·9 per cent) of 580 patients respectively. Twenty‐three patients (4·0 per cent) had respiratory complications and 98 (16·9 per cent) had postoperative ileus. Median length of hospital stay was 5 (i.q.r. 3–9) days. Based on respiratory complications, thresholds for perioperative intravenous fluid administration (postoperative day (POD) 0) were set pragmatically at 3000 ml for colonic (calculated threshold 3120 ml (area under ROC curve (AUROC) 0·63)) and 4000 ml for rectal (AUROC 0·79) procedures. Postoperative weight gain of 2·5 kg at POD 2 was predictive of respiratory complications. Multivariable analysis retained perioperative intravenous fluid administration over the above thresholds as an independent risk factor for overall (odds ratio (OR) 2·25, 95 per cent c.i. 1·23 to 4·11), major (OR 2·49, 1·17 to 5·31) and respiratory (OR 4·71, 1·42 to 15·58) complications. Weight gain above 2·5 kg at POD 2 was identified as a risk factor for respiratory complications (OR 3·58, 1·10 to 11·70) and ileus (OR 1·82, 1·02 to 3·52).

Perioperative intravenous fluid and weight thresholds were associated with postoperative adverse outcomes. These thresholds need independent validation.

• Enhanced recovery after surgery
• Oesophageal cancer
• Prehabilitation
• Surgery

• Gastrointestinal surgery
• Goal-directed fluid therapy
• Postoperative complications
• Stroke volume

• Edwards Lifesciences
• Grant of Intergrated Demonstration Project of Chongqing Science and Technology Commission

• Fast track recovery program
• active particpation of a hospitalist

• Colorectal surgery
• Complications
• Goal-directed fluid therapy
• Meta-analysis
• Mortality

• Complication
• Fluid management
• Goal-directed fluid therapy
• Pancreatoduodenectomy
• Visceral tissue edema

• Fluid therapy
• colorectal surgery
• intestinal fatty acid-binding protein
• perfusion

• Abdominal surgery
• Gastrointestinal function
• Goal-directed hemodynamic therapy
• Morbidity
• Mortality

Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care.

We performed a systematic review with a random-effects meta-analyses and meta-regression based on search strategy through MEDLINE, EMBASE and references in relevant articles. We included studies comparing conventional fluid management with goal-directed therapy and reporting whether urine output was used as target or not, and reporting 30-day mortality data in perioperative and critical care.

We found 36 studies in which goal-directed therapy reduced 30-day mortality (OR 0.825; 95% CI 0.684-0.995; P = 0.045). Targeting urine output within goal-directed therapy increased 30-day mortality (OR 2.66; 95% CI 1.06-6.67; P = 0.037), but not in conventional fluid management (OR 1.77; 95% CI 0.59-5.34; P = 0.305). After adjusting for operative setting, hemodynamic monitoring device, underlying etiology, use of vasoactive medication and year of publication, we found insufficient evidence to associate targeting urine output with a change in 30-day mortality (goal-directed therapy: OR 1.17; 95% CI 0.54-2.56; P = 0.685; conventional fluid management: OR 0.74; 95% CI 0.39-1.38; P = 0.334).

The principal finding of this meta-analysis is that after adjusting for confounders, there is insufficient evidence to associate targeting urine output with an effect on 30-day mortality. The paucity of direct data illustrates the need for further research on whether permissive oliguria should be a key component of fluid management protocols.

The online version of this article (doi:10.1186/s12871-017-0316-4) contains supplementary material, which is available to authorized users.

• Critical care
• Mortality
• Oliguria
• Perioperative care

• Abdominal surgery
• Goal-directed fluid therapy
• Surgical site infections

• Goal directed fluid therapy
• Hemodynamic target
• Major surgery
• Mortality
• Non-cardiac surgery
• Outcome
• Perioperative care

• Carbohydrate drink
• Colloids
• Colorectal surgery
• Crystalloids
• Enhanced recovery pathway
• Fluids
• Goal-directed fluid therapy
• Hemodynamics
• Enhanced recovery

• Atención perioperatoria
• Esophageal Doppler monitoring
• Fluidoterapia por objetivos
• Goal-directed fluid therapy
• Hemodynamic goal
• Meta-analysis
• Metaanálisis
• Monitorización Doppler esofágico
• Objetivo hemodinámico
• Perioperative care

• Echocardiography, Doppler
• Fluid Therapy
• Goals
• Hemodynamics
• Humans
• Postoperative Complications/prevention & control

• Gastric cancer
• Intraoperative fluid
• Perioperative outcomes

• Adult
• Blood Volume
• Critical Care
• Fluid Therapy/methods
• Fluid Therapy/standards
• Germany
• Humans
• Hypovolemia/therapy

To compare the effects of intraoperative goal-directed fluid therapy (GDFT) with conventional fluid therapy, and determine whether there was a difference in outcome between studies that did and did not use Enhanced Recovery After Surgery (ERAS) protocols.

Meta-analysis of randomized controlled trials of adult patients undergoing elective major abdominal surgery comparing intraoperative GDFT versus conventional fluid therapy. The outcome measures were postoperative morbidity, length of stay, gastrointestinal function and 30-day mortality.

A total of 23 studies were included with 2099 patients: 1040 who underwent GDFT and 1059 who received conventional fluid therapy. GDFT was associated with a significant reduction in morbidity (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.66–0.89, P = 0.0007), hospital length of stay (LOS; mean difference −1.55 days, 95% CI −2.73 to −0.36, P = 0.01), intensive care LOS (mean difference −0.63 days, 95% CI −1.18 to −0.09, P = 0.02), and time to passage of feces (mean difference −0.90 days, 95% CI −1.48 to −0.32 days, P = 0.002). However, no difference was seen in mortality, return of flatus, or risk of paralytic ileus. If patients were managed in an ERAS pathway, the only significant reductions were in intensive care LOS (mean difference −0.63 days, 95% CI −0.94 to −0.32, P < 0.0001) and time to passage of feces (mean difference −1.09 days, 95% CI −2.03 to −0.15, P = 0.02). If managed in a traditional care setting, a significant reduction was seen in both overall morbidity (RR 0.69, 95% CI 0.57 to −0.84, P = 0.0002) and total hospital LOS (mean difference −2.14, 95% CI −4.15 to −0.13, P = 0.04).

GDFT may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in an ERAS setting.

• abdominal surgery
• arterial pulse pressure waveform analysis
• cost-effectiveness
• esophageal Doppler
• goal-directed fluid therapy

• Abdomen/surgery
• Aged
• Arterial Pressure
• Blood Pressure Determination/economics
• Blood Pressure Determination/instrumentation
• Cardiac Output
• Cost Savings
• Cost-Benefit Analysis
• Decision Support Techniques
• Decision Trees
• Echocardiography, Doppler/economics
• Echocardiography, Doppler/instrumentation
• Esophagus/diagnostic imaging
• Fluid Therapy/economics
• France
• Hospital Costs
• Hospital Mortality
• Humans
• Middle Aged
• Models, Economic
• Monitoring, Intraoperative/economics
• Monitoring, Intraoperative/instrumentation
• Monitoring, Intraoperative/methods
• Monte Carlo Method
• National Health Programs/economics
• Postoperative Complications/economics
• Postoperative Complications/mortality
• Postoperative Complications/prevention & control
• Predictive Value of Tests
• Public Sector/economics
• Treatment Outcome

• Colloids
• Coloides
• Crystalloids
• Derivados de Hidroxietil Amido
• Fluid therapy
• Hidratacão
• Hidratacão guiada por objetivos
• Hydroxyethyl starch
• Meta-analysis
• Metanálise
• Objective-guided fluid therapy
• Revisão sistemática
• Soluções Isotônicas
• Systematic review

• Adult
• Colloids/administration & dosage
• Colloids/adverse effects
• Crystalloid Solutions
• Fluid Therapy/adverse effects
• Fluid Therapy/methods
• Humans
• Isotonic Solutions/administration & dosage
• Isotonic Solutions/adverse effects
• Randomized Controlled Trials as Topic
• Surgical Procedures, Operative/methods

• Fluid responsiveness
• Fluid resuscitation
• Goal-directed fluid therapy
• Perioperative fluids