Fluid use in the scheduled surgical patient.

CRITICAL CARE & EMERGENGY MEDICINE VOL. 2

Uso de líquidos en el paciente quirúrgico programado.

Enviar Artículo

 https://doi.org/10.58281/ccem23112304

Ernesto Arriaga-Morales 1 , George E. Benjamín Sánchez de la Barquera 2 , Angélica Contreras-Muñoz 3 , José Eduardo Rovelo Lima 4 , Ricardo Sánchez Zamora 5 , Rubén Isaac Olvera Rodríguez 6 , Patrick James Atherton Avila 7 , Ángel G. Nájera-Albarrán 8 , Rubén Orlando Pérez-Nieto 9 .

1 Emergency Department, Hospital San Ángel Inn Sur, Ciudad de México, México.
E-mail: urgencias.sur@hsai.com.mx
Twitter: @Ernesto_AM_MD
2 Orthopaedics and trauma, Hospital San Ángel Inn Sur, Ciudad de México, México.
E-mail: benjamin.edgar@insp.edu.mx 3 Ear, Throat & Nose, Hospital Ángeles Pedregal, Ciudad de México, México.
4 Teaching Department, Hospital San Ángel Inn Sur, Ciudad de México, México.
E-mail: lalomd@gmail.com 5 Gynaecology and Obstetrics, Hospital Ángeles Universidad, Ciudad de México, México.
E-mail: drsanchezzam@gmail.com 6 Emergency Department, Hospital San Ángel Inn Sur, Ciudad de México, México.
E-mail: risaacolverar@gmail.com 7 Medical Intern, Hospital San Ángel Inn Sur, Ciudad de México, México.
E-mail: atherton.av@gmail.com 8 Cardiology department, Hospital San Ángel Inn Sur, Ciudad de México, México.
E-mail: drnajeraci@gmail.com
Twitter: @angna_86
9 Intensive Care Unit, Hospital Regional San Juan del Río, San Juan del Rio, Querétaro.
E-mail: Orlando_rpn@hotmail.com
Twitter: @OrlandoRPN  

Abstract

Introduction: Fluid administration is almost universally accepted as a part of the treatment of any hospitalized patient, but this is based on old perspectives and an incomplete understanding of the intravenous fluid dynamics. A long time ago Shires et al described and defined a “third space” which is a nonfunctional fluid that can be considered a fluid loss and must be replaced; this understanding led to over reanimation1, 2. The surgical scheduled patient is a perfect example, most of those procedures don’t compromise the oral route, don’t imply large fluid loses, and don’t need large intravenous fluids even in complex cases like congenital heart defects. The lack of understanding has led to persistent overuse of intravenous fluids. New evidence suggests that the fluid response for hypotension is not the rule, but an exception to the rule in a specific situation. There is even evidence that the excretion of crystalloid fluid during hypotension is diminished and implies an increased risk of overload.

Introducción: La administración de líquidos es casi universalmente aceptada como parte del tratamiento de cualquier paciente hospitalizado, pero esto se basa en perspectivas antiguas y una comprensión incompleta de la dinámica de los líquidos intravenosos. Hace mucho tiempo, Shires et al. describieron y definieron un “tercer espacio”, que es un líquido no funcional que puede considerarse una pérdida de líquido y debe reemplazarse; esta comprensión condujo a una reanimación excesiva1, 2. El paciente quirúrgico programado es un ejemplo perfecto, la mayoría de esos procedimientos no comprometen la vía oral, no implican grandes pérdidas de líquido y no necesitan grandes líquidos intravenosos incluso en casos complejos como los defectos cardíacos congénitos. La falta de comprensión ha llevado al uso excesivo persistente de líquidos intravenosos. Nuevas evidencias sugieren que la respuesta de los líquidos para la hipotensión no es la regla, sino una excepción a la regla en una situación específica. Incluso hay evidencia de que la excreción de líquido cristaloide durante la hipotensión está disminuida e implica un mayor riesgo de sobrecarga.

Ernesto Arriaga-Morales  
Emergency Department, Hospital San Ángel Inn Sur, Ciudad de México, México.

George E. Benjamín Sánchez de la Barquera.
Orthopaedics and trauma, Hospital San Ángel Inn Sur, Ciudad de México, México.

Angélica Contreras-Muñoz
 Ear, Throat & Nose, Hospital Ángeles Pedregal, Ciudad de México, México.

José Eduardo Rovelo Lima
Teaching Department, Hospital San Ángel Inn Sur, Ciudad de México, México.

Ricardo Sánchez Zamora
Gynaecology and Obstetrics, Hospital Ángeles Universidad, Ciudad de México, México.

Rubén Isaac Olvera Rodríguez
Emergency Department, Hospital San Ángel Inn Sur, Ciudad de México, México.

Patrick James Atherton Avila 
Medical Intern, Hospital San Ángel Inn Sur, Ciudad de México, México.

Ángel G. Nájera-Albarrán 
Cardiology department, Hospital San Ángel Inn Sur, Ciudad de México, México.

Rubén Orlando Pérez-Nieto 9 .
Intensive Care Unit, Hospital Regional San Juan del Río, San Juan del Rio, Querétaro.

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[1] Ernesto Arriaga-Morales, George E. Benjamín Sánchez de la Barquera, Angélica Contreras-Muñoz, José Eduardo Rovelo Lima, Ricardo Sánchez Zamora, Rubén Isaac Olvera Rodríguez, Patrick James Atherton Avila, Ángel G. Nájera-Albarrán, y Rubén Orlando Pérez-Nieto. 2023. Fluid use in the scheduled surgical patient. CRITICAL CARE & EMERGENCY MEDICINE. Vol. 2, pp. 16–19. DOI: https://doi.org/10.58281/ccem23112304.
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