In patients who undergo abdominal surgeries in emergency, does the ratio of fluid balance to oncotic pressure in blood vessels correlate with surgical outcomes?
- Conditions
- Medical and Surgical,
- Registration Number
- CTRI/2024/03/063491
- Brief Summary
Fluid therapy is the cornerstone of patient management in the perioperative setting. While a liberal approach to fluid therapy was used in the past to prevent hypovolemia and improve organ perfusion, it was shown that tissue inflammation and consequent extravascular leak led to fluid accumulation in the third space, contributing to perioperative complications. As evidence emerged that a positive fluid balance was associated with increased risk of adverse surgical outcomes as well as organ dysfunction, such as acute lung injury, acute kidney injury and prolonged duration of mechanical ventilation and ICU stay, restricted or goal-directed fluid therapy (zero-balance approach) began to replace the conventional approach to fluid management.
Whenever intravenous fluid therapy is administered for any reason, only a portion of the total fluid received stays inside the intravascular compartment; the rest extravasates into the capillary interstitial space. Adverse effects of intravenous fluid therapy often relate to this extravasation of intravascular fluid, as it causes tissue edema and decreased tissue oxygen delivery leading to poor clinical outcome. One of the four major Starling forces, the plasma colloid oncotic pressure determines the intravascular stay of fluid. Inflammation causes endothelial damage leading to leaky capillaries that exude fluid and protein, reducing the oncotic pressure. Albumin being a negative acute phase reactant is reduced in the perioperative setting and contributes to a lowered value of colloid oncotic pressure.
We postulate that this decreased plasma oncotic pressure might contribute to enhanced extravascular leak that leads to poorer outcomes. While a number of studies have shown adverse clinical outcomes associated with a positive fluid balance intra- and post-operatively, the effect of a reduced colloid oncotic pressure has not been studied in the perioperative period for non-cardiac surgeries. Furthermore, no study has attempted to see if the ratio of positive cumulative fluid balance to colloid oncotic pressure can be a useful predictor for post-operative complications.
Study hypothesis: Higher cumulative fluid balance to estimated colloid oncotic pressure ratio will be associated with poorer outcomes in patients undergoing emergency abdominal surgery
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- All
- Target Recruitment
- 200
Adult patients (aged 18-75 years) Either sex Undergoing emergency abdominal surgery Duration of surgery at least 2 hours.
Refusal to participate CKD stage IV or V AKI stage III or more at the time of admission Pregnancy Moribund patients with expected survival <48 hours.
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Association between cumulative fluid balance to estimated colloid oncotic pressure ratio at 48 hours and any grade of Clavien-Dindo complication after emergency abdominal surgery 30 days postoperatively
- Secondary Outcome Measures
Name Time Method Association between cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours and postoperative AKI within postoperative day 7 7 days postoperatively Association between cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours and hospital free days at day 30 30 days postoperatively Association between perioperative fluid balance to estimated colloid oncotic pressure ratio (hospital admission to end of surgery) and postoperative complications 30 days postoperatively Association between cumulative fluid balance/estimated colloid oncotic pressure ratio at 48 hours and 30-day mortality 30 days postoperatively Association between cumulative fluid balance to estimated colloid oncotic pressure ratio at 48 hours and Clavien-Dindo grade IVa/b and V complication 30 days postoperatively
Trial Locations
- Locations (1)
All India Institute of Medical Sciences, New Delhi
🇮🇳Delhi, DELHI, India
All India Institute of Medical Sciences, New Delhi🇮🇳Delhi, DELHI, IndiaDr ArushiPrincipal investigator9205678052mailtoarushi511@gmail.com