| Title |
Perioperacinės transfuzinės ir skysčių terapijos ypatumai atliekant planinį klubo ir kelio sąnario endoprotezavimą / |
| Translation of Title |
Issues of perioperative transfusion and fluid therapy in elective total hip and knee arthroplasty surgery. |
| Authors |
Andrijauskas, Audrius ; Ivaškevičius, Juozas ; Kocius, Manvilius ; Porvaneckas, Narūnas |
| DOI |
10.15388/LietChirur.2008.2.2154 |
| Full Text |
|
| Is Part of |
Lietuvos chirurgija.. Vilnius : Vilniaus universiteto leidykla. 2008, t. 6, Nr. 2, p. 112-133.. ISSN 1392-0995. eISSN 1648-9942 |
| Keywords [eng] |
anemia ; blood ; fluid ; transfusion ; algorithm |
| Abstract [eng] |
Fluid and red cell administration is a critical component of perioperative treatment in major surgery. It is apparent from the literature that operating a normohydrated patient is associated with fewer complications and a shorter hospital stay. However, numerous patients receive excessive fluid therapy with the resulting volume overload and organ dysfunction. Oedema contributes to tissue hypoxia, delayed wound healing and an increased risk of infection. On the other hand, inadequate fluid resuscitation promotes gut ischaemia which is one of the initiating causes of sepsis and multi-organ failure. Therefore, optimizing the patients' perioperative hydration may improve the clinical outcome. However, traditionally used haemodynamic parameters, such as arterial blood pressure, central venous or pulmonary arthery wedge pressures, are unreliable for optimizing fluid therapy. The most promising method, the "goal-directed fluid therapy", implies that cardiac output is measured before and after consequitive intravenous test-fluid loads. The procedure is repeated until no further increase in cardiac output is achieved. In such a way the circualting blood volume is optimized so that cardiac output is maximized. Similarly, in the treatment of perioperative hypotension, the blood pressure response to the test-fluid load can be monitored, suggesting that the patient will not benefit from the further fluid infusion when the haemodynamic response becomes inadequate. The transfusion decission-making continues being a never-ending debate. Acknowledging the need for surgery and patient specific strategies in perioperative fluid management and transfusion decision-making, as well as the existing variability in individual practices, in this review the authors introduced their new algorithms applicable to patients who undergo elective total hip and knee arthroplasty. |
| Published |
Vilnius : Vilniaus universiteto leidykla |
| Type |
Journal article |
| Language |
Lithuanian |
| Publication date |
2008 |
| CC license |
|
