Faculty Advisor(s)

Cheryl Nimmo

Document Type

Capstone

Publication Date

6-2017

Rights

© 2017 Mark Yacovone

Abstract

Anesthetists provide intra-operative fluid therapy by utilizing a variety of different methods. Deciding on the appropriate method is multifaceted, and the choice of method is a determinate of safe and effective outcomes. Camach-Navarro et al. (2015) determined that postoperative complications are linked to either giving too much or too little fluid. Unfortunately, the deleterious effects of improper fluid therapy are often overlooked.

Minor surgical procedures which result in little to no blood loss, often lead to positive outcomes using the fixed volume calculation approach to fluid therapy. However, when major surgical procedures are performed on sick patients a fluid management plan must be established. When fluid replacement is based on first applying fixed volume calculations, followed by assessing urine output or providing intraoperative loss replacement (restrictive therapy), improper volumes may result. Gutierrez, Moore, & Liu. (2013) found that empirical calculations do not factor in the specific procedure type and physiological effect on the patient. The lack of specificity demonstrates the limitations in fixed volume fluid calculations when managing major surgical procedures on sick patients. Surgeries that incorporate hemodynamic instability require careful fluid replacement volumes. Goal directed fluid therapy is deployed when improper fluid volumes may lead to serious negative patient outcomes.

Research shows that monitoring fluid responsiveness reduces the incidence of improper fluid volumes, and should be guided by goal-directed fluid therapy (Camach-Navarro et al., 2015). Goal- directed fluid therapy is defined as administering intravenous fluids to achieve a desired goal (Trinooson & Gold, 2013). Fluid responsiveness is defined as an increase in stroke volumeor cardiac output upon fluid loading (Cherpanath, Geerts, Legrand, Schultz, & Groeneveld, 2013).

The importance of ongoing research in discovery of the best practice techniques involving fluid administration is necessary to provide outstanding patient care. Research and local practice standards offer a variety of fluid therapy methods. The question is which fluid therapy technique is best suited for specific surgeries and specific patient types. Current research is investigating the possible benefit of utilizing dynamic index monitoring of stroke volume variation as a guide to goal-directed fluid therapy.

Comments

Master's capstone

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