Optimizing restoration of intestinal function in moderate-risk surgical patients with abdominal emergencies using different infusion therapy regimens
Keywords:urgent surgery, infusion therapy, postoperative intestinal obstruction, intraabdominal hypertension, sonographic diagnostics
The aim of the study was to evaluate the effectiveness of liberal and restrictive regimens of infusion therapy based on a comparative analysis of the postoperative bowel motor function recovery in moderate-risk surgical patients with abdominal emergencies.
Materials and methods. In a prospective study, 70 patients with emergency pathology of the abdominal cavity were randomly examined, urgently operated by laparotomy. Perioperative infusion therapy was performed in the liberal (n = 35) and restrictive (n = 35) regimens. The volume of body water sectors was determined rheographically and the interstitium volume was calculated. Intestinal function was assessed physically, by measuring the residual gastric volume and intraabdominal pressure, and the intestinal wall sonographic visualization.
Results. In patients with abdominal emergency receiving the liberal regimen of perioperative infusion therapy, an interstitial edema development was found (P < 0.001). This correlated with an increase in diameter (R = 0.78, P = 0.02) and intestinal wall thickness (R = 0.86, P = 0.02) and was accompanied by I degree intra-abdominal hypertension development from the 1st to the 5th day. A low motor-evacuation function of the stomach was clinically observed up to the 3rd day, the paradoxical pendular peristalsis was up to the 5th day. Intestinal motor-evacuation function was restored in 49 % of patients from the 7th day. In the restrictive regimen of infusion therapy, the physiological interstitial volume was preserved with an increased wall thickness (P < 0.02) and diameter (P < 0.001) of the small intestine on day 1 and 3 after surgery without signs of intraabdominal hypertension. The motor-evacuation function of the stomach was restored in 85 % of patients from the 3 day, and of the intestine – in 79 % of patients from the 5th day.
Conclusions. The perioperative liberal regimen of infusion therapy in moderate-risk surgical patients with abdominal emergencies is accompanied by interstitial intestinal edema, I degree intraabdominal hypertension, longer recovery time of postoperative intestinal failure up to the 7 day after surgery. The restrictive regimen of infusion prevents the development of interstitial edema and intraabdominal hypertension, helps to reduce the time for the motor-evacuation function of the gastrointestinal tract full recovery up to 5 days.
Murray, D. (2014). Improving outcomes following emergency laparotomy. Anaesthesia, 69(4), 300-305. https://doi.org/10.1111/anae.12620
Oliver, C. M., Walker, E., Giannaris, S., Grocott, M. P., & Moonesinghe, S. R. (2015). Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. British Journal of Anaesthesia, 115(6), 849-860. https://doi.org/10.1093/bja/aev350
Vivekanand, K. H., Mohankumar, K., Prakash, D., Vikranth, S. N., & Suresh, T. N. (2015). Clinical Outcome of Emergency Laparotomy: Our Experience at tertiary care centre (A case series). International Journal of Biomedical and Advance Research, 6(10), 709-714. https://doi.org/10.7439/ijbar.v6i10.2578
Thacker, J. K., Mountford, W. K., Ernst, F. R., Krukas, M. R., & Mythen, M. M. (2016). Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations. Annals of Surgery, 263(3), 502-510. https://doi.org/10.1097/SLA.0000000000001402
Bragg, D., El-Sharkawy, A. M., Psaltis, E., Maxwell-Armstrong, C. A., & Lobo, D. N. (2015). Postoperative ileus: Recent developments in pathophysiology and management. Clinical Nutrition, 34(3), 367-376. https://doi.org/10.1016/j.clnu.2015.01.016
Gero, D., Gié, O., Hübner, M., Demartines, N., & Hahnloser, D. (2017). Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbeck's Archives of Surgery, 402(1), 149-158. https://doi.org/10.1007/s00423-016-1485-1
Venara, A., Slim, K., Regimbeau, J. M., Ortega-Deballon, P., Vielle, B., Lermite, E., Meurette, G., & Hamy, A. (2017). Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery. International Journal of Colorectal Disease, 32(6), 797-803. https://doi.org/10.1007/s00384-017-2788-6
Lluis, N., & Biondo, S. (2018). Prolonged postoperative ileus after colorectal surgery: still an unresolved problem. Annals of Laparoscopic and Endoscopic Surgery, 3(3), Article 15. https://doi.org/10.21037/ales.2018.02.06
Lee, T. H., Lee, J. S., Hong, S. J., Jang, J. Y., Jeon, S. R., Byun, D. W., Park, W. Y., Kim, S. I., Choi, H. S., Lee, J. C., & Lee, J. S. (2015). Risk Factors for Postoperative Ileus Following Orthopedic Surgery: The Role of Chronic Constipation. Journal of Neurogastroenterology and Motility, 21(1), 121-125. https://doi.org/10.5056/jnm14077
National Institute for Health and Care. (2013, December 10). Intravenous fluid therapy in adults in hospital. NICE. https://www.nice.org.uk/guidance/cg174
Boland, M. R., Noorani, A., Varty, K., Coffey, J. C., Agha, R., & Walsh, S. R. (2013). Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, clinical trials. World Journal of Surgery, 37(6), 1193-1202. https://doi.org/10.1007/s00268-013-1987-8
Vydavnychyi dim «Zdorovia Ukrainy» (2018, March 28). Khirurh: Standarty orhanizatsii ta profesiino oriientovani protokoly nadannia medychnoi dopomohy khvorym z nevidkladnoiu khirurhichnoiu patolohiieiu orhaniv zhyvota [Surgeon: Standards of organization and professionally oriented protocols for providing medical care to patients with urgent surgical pathology of the abdominal organs]. https://accemedin.com/material/30/230 [in Ukrainian].
Carlisle, J. B. (2019). Risk prediction models for major surgery: composing a new tune. Anaesthesia, 74(Suppl. 1), 7-12. https://doi.org/10.1111/anae.14503
Kravets, O. V., Klyhunenko, O. M., & Sedinkin, V. A. (2018). Sposib perioperatyvnoi infuziinoi terapii u khvorykh pry nevidkladnii patolohii orhaniv cherevnoi porozhnyny [The method of perioperative infusion therapy in patients with urgent pathology of the abdominal cavity]. (Ukraine. Patent No. 128084). Ukraina. Derzhavna sluzhba intelektualnoi vlasnosti Ukrainy. https://base.uipv.org/searchINV/search.php?action=viewdetails&IdClaim=250595 [in Ukrainian].
Hoste, E. A., Maitland, K., Brudney, C. S., Mehta, R., Vincent, J. L., Yates, D., Kellum, J. A., Mythen, M. G., Shaw, A. D., & ADQI XII Investigators Group. (2014). Four phases of intravenous fluid therapy: a conceptual model. British Journal of Anaesthesia, 113(5), 740-747. https://doi.org/10.1093/bja/aeu300
Kyle, U. G., Bosaeus, I., De Lorenzo, A. D., Deurenberg, P., Elia, M., Manuel Gómez, J., Lilienthal Heitmann, B., Kent-Smith, L., Melchior, J. C., Pirlich, M., Scharfetter, H., M. W. J Schols, A., Pichard, C., & ESPEN. (2004). Bioelectrical impedance analysis-part II: utilization in clinical practice. Clinical Nutrition, 23(6), 1430-1453. https://doi.org/10.1016/j.clnu.2004.09.012
Barzegari, H., Delirooyfard, A., Moatamedfar, A., Sohani, S., & Sohani, M. (2016). A New Point of Care Ultrasound in disposition of patients with small bowel obstruction in Emergency Department. International Journal of Pharmaceutical Research & Allied Sciences, 5(2), 200-207.
Hollerweger, A., Wüstner, M., & Dirks, K. (2015). Bowel Obstruction: Sonographic Evaluation. Ultraschall in der Medizin, 36(3), 216-238. https://doi.org/10.1055/s-0034-1399292
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