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Intravenous fluids for abdominal aortic surgeryZavrakidis N
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SummaryIntravenous fluids for abdominal aortic surgerySurgery on the abdominal aorta (the main artery to the legs) is major surgery. Fluid replacement is needed to replace what is lost during surgery. Blood products, non-blood products or combinations are used, including crystalloids or colloids. Combination therapy is most common. The review of trials found there was not enough evidence of the benefits of either individual or combination fluid therapies. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 23. 2000 AbstractBackgroundSurgery on the abdominal aorta, for aneurysmal and occlusive disease, is a major undertaking which requires intensive support and fluid management. Blood products are often used, but the major fluid replacement is with crystalloids or colloids. There has been controversy for many years over which fluid is optimal and a number of studies have examined this subject, without any systematic review. ObjectivesThe objective of this review was to determine the effectiveness of different non-blood replacement fluids used in surgery on the abdominal aorta with a view to identifying the optimal fluid for use in such surgery. Search strategyAll publications describing (or which might describe) randomised controlled trials of non-blood replacement fluids in abdominal aortic surgery were sought using the search strategy described by the Cochrane Review Group on Peripheral Vascular Diseases. This strategy includes hand searching of relevant medical journals and extensive MEDLINE and EMBASE searches. In addition, trials have been identified from searches of references included in those trials already retrieved. Selection criteriaRandomised controlled trials assessing the effects of one or more specific non-blood fluids used for replacement therapy in operations on, and confined to, the abdominal aorta. Data collection and analysisData were extracted to pre-prepared tables and then entered into the Review Manager software where statistical analysis and descriptive subjective analysis were performed. Main resultsSixteen trials involving 604 patients were included. Patients undergoing aortic surgery had various physiological parameters measured before and after their operation (cardiac, respiratory, biochemical, haematological and protein). Sixteen fluids were studied: Ringer lactate, 5% dextrose in Ringer lactate, 5% dextrose in 0.45% saline, 5% dextrose in water, 1.8% saline, mannitol, human albumin solution in Ringer lactate, human albumin solution in water, 5% dextrose with human albumin solution, Dextran 60, Dextran 70, Hetastarch, bovine hemoglobin-based oxygen carrier (HBOC-201), 6% hydroxyethyl starch (HES), hypertonic HES (6%HES, 7.2% NaCl), isotonic HES (6% HES, 0.9% NaCl). Patients were randomised to fluid type. This review demonstrates that no single fluid has been shown to affect any outcome measure significantly more than any other across a range of outcome measures. However, each trial compared different fluids, and each fluid has not been compared against all others. The death rate in these studies was 2.3% (14 patients). Authors' conclusionsFurther studies are required, with sufficient sample size and power, to draw any further conclusions. There are no studies examining the effects of combination fluid therapy. |