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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Acid-based disturbances due to perioperative fluid therapy with slightly alkalized and acid-based neutral balanced crystalloids: a comparative study

Abstract

The study aimed at comparing the effects of perioperatively administered balanced crystalloid infusion solutions, containing varied quantities of metabolizable anions, on homeostasis. In the prospective randomized open label study, patients were assigned to Plasmalyte (PL) and Ringerfundin (RF) Groups. The infusion solutions were parenterally administered at 1000 mL/6 hours. Arterialized capillary blood was sampled at the time of transfer to the Intensive Care Unit (ICU) (Time 0), and again at both 2 and 6 hours from Time 0. The collected blood was tested for blood gas parameters. A total of 112 patients were enrolled in the study. There was no significant difference (P=0.329) in baseline pH values between the same-sized PL and RF Groups, with median pH values of 7.34 and 7.32, respectively. Similarly, no significant differences were seen in pH values measured after 2 hours (P=0.436), with median values of 7.38 for the PL Group and 7.37 for the RF Group. Finally, no significant differences were observed after 6 hours (P=0.528), with median values of 7.41 and 7.40, respectively. Over time, pH values increased significantly in both groups (P≤0.001). There were no significant changes in either baseline base excess, actual bicarbonate, standard bicarbonate, partial pressure O2 and CO2 values, measured after 2 and 6 hours between the PL and RF Groups. The study failed to show differences between the balanced solutions Plasmalyte, in 5% glucose, and Ringerfundin, on the effects of pH and other acid-base parameters in patients receiving postoperative care following elective surgery.

Key words: crystalloids, fluid therapy, Plasmalyte, Ringerfundin, acid base, internal environment

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Current concepts in fluid therapy and non-invasive haemodynamic monitoring

Abstract

Advantages of goal directed therapy (GDT) have recently become more and more difficult to prove in the face of newly implemented protocolised patient care approaches that also clearly improve patient outcome. However, individualised approach using GDT has been suggested to be superior to protocolised care and large meta-analyses still consistently show beneficial effects of GDT. Concerns of invasiveness were the reason why some patients’ haemodynamics was not measured and in turn were not included in any GDT protocols. Recently, non-invasive devices to measure arterial blood pressure and haemodynamic variables emerged, and although they are very appealing and easy to use, they require further validation both by comparison to more invasive methods and by outcome trials.

Keywords: Haemodynamic monitoring, non-invasive haemodynamic monitoring, goal-directed therapy, fluid therapy, validation

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