An audit of fluid treatment during surgeries in preplanned surgeries
- Conditions
- Neoplasms,
- Registration Number
- CTRI/2022/08/044946
- Lead Sponsor
- Tata Memorial Hospital
- Brief Summary
Background:
Traditionally, intraoperative fluid administration followed a liberal approach in order to counteract starvation deficits and ‘third space’ losses. However, the concept of ‘third space’ has been challenged. Thus routine infusions of large volumes of intravenous fluid intraoperatively can lead to fluid overload leading to tissue oedema. This in turn increases the oxygen transfer distance, thereby increasing the risk of poor surgical-site healing and postoperative complications such as anastomotic leak and a prolonged length of hospital stay (LOS). Restrictive fluid regimens often aim for a low or zero net fluid balance and restrictive protocols often recommend use of vasopressors to maintain blood pressure. However intraoperative hypovolemia and inappropriate use of vasopressors could increase the risk of tissue hypo perfusion leading to organ dysfunction. Recent studies have shown increased risk of acute kidney injury.
Cardiac output monitoring with stroke volume optimisation has been commonly used in goal directed therapy studies in recent years.
Optimal preoperative fluid administration in cancer surgery is a challenging clinical problem as cancer surgery often involves extensive dissection, lymph node clearance and blood loss. This along with systemic inflammatory response causes significant fluid shifts and complicates fluid management.
Thus in the current scenario though liberal fluid is discouraged, it is still unclear as to how much fluid administration should be considered as standard as different studies have used different fluid administration rates. This retrospective observational study is aimed at understanding our current intraoperative fluid management practice in elective cancer surgery and its effect on the intraoperative and post operative course in terms of major complications. This data will help us understand of fluid management strategies across surgical specialties and focus studies on particular aspect of fluid management.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Closed to Recruitment of Participants
- Sex
- All
- Target Recruitment
- 1000
All adult patients undergoing elective cancer surgery.
Patients with blood loss more than 1 litre.
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Intraoperative IV fluid volume in ml / ideal body weight / hr and type of IV fluids used in different types of surgery. 12 hours
- Secondary Outcome Measures
Name Time Method 2. In hospital complications will include - Anastomotic dehiscence, ICU /RR stay 48 hrs, sepsis, ICU readmission, re surgery or organ dysfunction. Cardiovascular complications will be defined as any haemodynamic abnormality requiring intervention, need for mechanical ventilation, acute kidney injury, Respiratory complications will be defined as need for mechanical ventilation including HFNC or NIV. CNS dysfunction and liver dysfunction will also be noted 30 days 1. Intraoperative complications such as need for vasopressor therapy, need for mechanical ventilation at the end of surgery or side effects of colloids. 30 days
Trial Locations
- Locations (1)
Tata Memorial Hospital
🇮🇳Mumbai, MAHARASHTRA, India
Tata Memorial Hospital🇮🇳Mumbai, MAHARASHTRA, IndiaDr Madhavi ShetmahajanPrincipal investigator9819372075mshetmahajan@hotmail.com