Comparación de los días libres de ventilación mecánica invasiva con la estrategia de fluidoterapia restrictiva vs convencional en pacientes postoperados de neurocirugía: cohorte retrospectivo

CRITICAL CARE & EMERGENGY MEDICINE VOL. 5

Comparison of ventilator-free days with a restrictive versus conventional fluid therapy strategy in postoperative neurosurgical patients: cohort

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www.doi.org/10.58281/ccem060126-invst-03

Zaida Solano Valencia 1 , Eduardo Perez Lozano  2, Edwin Zoquiapa Galaviz 2 .

1 Médico residente de Anestesiología. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

2 Médico pasante en investigación. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

Editor
Lizeth Rojas Corona , Liliana Catalina Galeana Gonzalez .

Chair
Diego Escarraman Martinez .

Abstract

Abstract: Optimal fluid management in neurosurgical patients is crucial to maintain adequate cerebral perfusion and limit complications such as cerebral edema; however, the available evidence regarding the effects of restrictive and conventional strategies on respiratory outcomes remains contradictory.
Objective: To determine the difference in the mean number of invasive mechanical ventilator-free days in postoperative neurosurgical patients managed with a restrictive versus a conventional fluid therapy strategy.
Material and methods: Retrospective cohort study including 117 adult patients who underwent brain tumor resection in a high-specialty center. Patients were classified into two groups according to the administered fluid therapy strategy (restrictive vs conventional), and the number of invasive mechanical ventilator-free days during the first days of the postoperative period was compared. Descriptive and comparative analyses were performed, as well as Cox regression models to explore the association between clinical variables and ventilator-free days.
Results: No statistically significant differences were observed in ventilator-free days between the restrictive strategy (4.04 days [3.37]) and the conventional strategy (4.22 days [2.79]); p = 0.76. Intraoperative blood loss (HR: 1.00; 95% CI: 1.00– 1.00; p = 0.02) and FiO2 (HR: 1.05; 95% CI: 1.00–1.10; p = 0.01) were associated with a lower number of ventilator-free days.
Conclusions: In this cohort of neurosurgical patients, a restrictive or conventional fluid therapy strategy did not modify the number of invasive mechanical ventilator-free days. Factors such as intraoperative blood loss and ventilatory parameters like FiO2 appear to have a greater impact on the duration of ventilatory support and should be considered when optimizing perioperative management.

Resumen: Introducción: La gestión óptima de fluidos en pacientes neuroquirúrgicos es crucial para mantener una perfusión cerebral adecuada y limitar complicaciones principalmente el edema cerebral; sin embargo, la evidencia disponible sobre los efectos de las estrategias restrictiva y convencional en los desenlaces respiratorios sigue siendo contradictoria.
Objetivo: Determinar la diferencia en el promedio de días libres de ventilación mecánica invasiva en pacientes postoperados de neurocirugía sometidos a una estrategia de fluidoterapia restrictiva frente a una convencional.
Material y métodos: Estudio de cohorte retrospectivo que incluyó 117 pacientes adultos sometidos a resección de tumor cerebral en una unidad de alta especialidad. Los pacientes se clasificaron en dos grupos según la estrategia de fluidoterapia administrada (restrictiva vs convencional) y se comparó el número de días libres de ventilación mecánica invasiva posterior al procedimiento quirúrgico. Se realizó análisis descriptivo y comparativo, así como modelos de regresión de Cox para explorar la asociación entre variables clínicas y los días libres de ventilación.
Resultados: No se observaron diferencias estadísticamente significativas en los días libres de ventilación mecánica entre la estrategia restrictiva (4.04 días [3.37]) y la convencional
(4.22 días [2.79]); p=0.76. El sangrado intraoperatorio (HR: 1.00; IC 95%: 1.00–1.00; p=0.02) y la FiO2 (HR: 1.05; IC 95%: 1.00–1.10; p=0.01) mostraron asociación con una menor cantidad de días libres de ventilación mecánica.
Conclusiones: En esta cohorte de pacientes neuroquirúrgicos, la estrategia de fluidoterapia restrictiva o convencional no modificó los días libres de ventilación mecánica invasiva. Factores como el sangrado intraoperatorio y parámetros
ventilatorios como la FiO2 parecen tener mayor impacto en la duración del soporte ventilatorio y deben considerarse en la optimización del manejo perioperatorio.

Respiration, Artificial; Fluid Therapy; Neurosurgical Procedures; Brain Neoplasms; Cohort Studies

Zaida Solano Valencia.
Médico residente de Anestesiología. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

Eduardo Perez Lozano.
Médico pasante en investigación. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

Edwin Zoquiapa Galaviz.
Médico pasante en investigación. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

  1. Ryu T. Fluid management in patients undergoing neurosurgery. Anesth Pain Med (Seoul). 2021 Jul;16(3):215-224. doi: 10.17085/apm.21072.
  2. Hourmant Y, Huard D, Demeure Dit Latte D, Bouras M, Asehnoune K, Pirrachio R, Roquilly A. Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2023 Apr;42(2):101177. doi: 10.1016/j.accpm.2022.101177.
  3. ommasino C, Picozzi V. Volume and electrolyte management. Best Pract Res Clin Anaesthesiol. 2007 Dec;21(4):497-516. doi:10.1016/j.bpa.2007.07.002.
  4. Frisvold S, Coppola S, Ehrmann S, Chiumello D, Guérin C. Respiratory challenges and ventilatory management in different types of acute brain-injured patients. Crit Care. 2023 Jun 23;27(1):247. doi: 10.1186/s13054-023-04532-4.
  5. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al; Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003 Nov;238(5):641-8. doi: 10.1097/01.sla.0000094387.50865.23.
  6. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al; Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018 Jun 14;378(24):2263-2274. doi: 10.1056/NEJMoa1801601.
  7. Wrzosek A, Jakowicka-Wordliczek J, Zajaczkowska R, Serednicki WT, Jankowski M, Bala MM, Swierz MJ, et al. Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery. Cochrane Database Syst Rev. 2019 Dec 12;12(12):CD012767. doi: 10.1002/14651858.CD012767.pub2.
  8. Yang TX, Tan AY, Leung WH, Chong D, Chow YF. Restricted Versus Liberal Versus Goal-Directed Fluid Therapy for Non-vascular Abdominal Surgery: A Network Meta-Analysis and Systematic Review. Cureus. 2023 Apr 28;15(4):e38238. doi: 10.7759/cureus.38238.
  9. Serpa Neto A, Deliberato RO, Johnson AEW, Bos LD, Amorim P, Pereira SM, et al; PROVE Network Investigators. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018 Nov;44(11):1914-1922. doi: 10.1007/s00134-018-5375-6.
  10. Dąbrowski W, Woodcock T, Rzecki Z, Malbrain MLNG. The use of crystalloids in traumatic brain injury. Anaesthesiol Intensive Ther. 2018;50(2):150-159. doi: 10.5603/AIT.a2017.0067.
  11. Esteban-Zubero E, García-Muro C, Alatorre-Jiménez MA. The Role of Fluid Therapy in Traumatic Brain Injury. DUNCAN LOWELLT, ed. Advances in Health and Disease. Vol 57. S.l.:NOVA SCIENCE; 2022.
  1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct 20;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD.
  1. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84. doi:10.1159/000339789.
  2. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009 Nov;41(4):1149-60. doi:10.3758/BRM.41.4.1149.
  3. Lindenblatt N, Park S, Alsfasser G, Gock M, Klar E. Intraoperative flüssigkeitstherapie bei pankreasresektionen–die sicht des chirurgen [Intraoperative fluid management in pancreatic resections–the surgeon’s view]. Zentralbl Chir. 2008 Apr;133(2):168-75. German. doi: 10.1055/s-2008-1004745.
  4. Han JW, Oh AY, Seo KS, Na HS, Koo BW, Lee YJ. Comparison of intraoperative basal fluid requirements in distal pancreatectomy: Laparotomy vs. laparoscopy: A retrospective cohort study. Medicine (Baltimore). 2017 Nov;96(47):e8763. doi:10.1097/MD.0000000000008763.
  5. Serpa Neto A, Deliberato RO, Johnson AEW, Bos LD, Amorim P, Pereira SM, et al; PROVE Network Investigators. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018 Nov;44(11):1914-1922. doi: 10.1007/s00134-018-5375-6.
  6. Frisvold S, Coppola S, Ehrmann S, Chiumello D, Guérin C. Respiratory challenges and ventilatory management in different types of acute brain-injured patients. Crit Care. 2023 Jun 23;27(1):247. doi: 10.1186/s13054-023-04532-4.
[1] Zaida Solano Valencia, Eduardo Perez Lozano, and Edwin Zoquiapa Galaviz. 2026. Comparación de los días libres de ventilación mecánica invasiva con la estrategia de fluidoterapia restrictiva vs convencional en pacientes postoperados de neurocirugía: cohorte retrospectivo. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 59–69. https://doi.org/10.58281/ccem060126-invst-03
PDF
HTML

Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

www.doi.org/10.58281/ccem060126-invst-03

Zaida Solano Valencia 1 , Eduardo Perez Lozano  2, Edwin Zoquiapa Galaviz 2 .

1 Médico residente de Anestesiología. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

2 Médico pasante en investigación. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

Editor
Lizeth Rojas Corona , Liliana Catalina Galeana Gonzalez .

Chair
Diego Escarraman Martinez .

Abstract

Abstract: Optimal fluid management in neurosurgical patients is crucial to maintain adequate cerebral perfusion and limit complications such as cerebral edema; however, the available evidence regarding the effects of restrictive and conventional strategies on respiratory outcomes remains contradictory.
Objective: To determine the difference in the mean number of invasive mechanical ventilator-free days in postoperative neurosurgical patients managed with a restrictive versus a conventional fluid therapy strategy.
Material and methods: Retrospective cohort study including 117 adult patients who underwent brain tumor resection in a high-specialty center. Patients were classified into two groups according to the administered fluid therapy strategy (restrictive vs conventional), and the number of invasive mechanical ventilator-free days during the first days of the postoperative period was compared. Descriptive and comparative analyses were performed, as well as Cox regression models to explore the association between clinical variables and ventilator-free days.
Results: No statistically significant differences were observed in ventilator-free days between the restrictive strategy (4.04 days [3.37]) and the conventional strategy (4.22 days [2.79]); p = 0.76. Intraoperative blood loss (HR: 1.00; 95% CI: 1.00– 1.00; p = 0.02) and FiO2 (HR: 1.05; 95% CI: 1.00–1.10; p = 0.01) were associated with a lower number of ventilator-free days.
Conclusions: In this cohort of neurosurgical patients, a restrictive or conventional fluid therapy strategy did not modify the number of invasive mechanical ventilator-free days. Factors such as intraoperative blood loss and ventilatory parameters like FiO2 appear to have a greater impact on the duration of ventilatory support and should be considered when optimizing perioperative management.

Resumen: Introducción: La gestión óptima de fluidos en pacientes neuroquirúrgicos es crucial para mantener una perfusión cerebral adecuada y limitar complicaciones principalmente el edema cerebral; sin embargo, la evidencia disponible sobre los efectos de las estrategias restrictiva y convencional en los desenlaces respiratorios sigue siendo contradictoria.
Objetivo: Determinar la diferencia en el promedio de días libres de ventilación mecánica invasiva en pacientes postoperados de neurocirugía sometidos a una estrategia de fluidoterapia restrictiva frente a una convencional.
Material y métodos: Estudio de cohorte retrospectivo que incluyó 117 pacientes adultos sometidos a resección de tumor cerebral en una unidad de alta especialidad. Los pacientes se clasificaron en dos grupos según la estrategia de fluidoterapia administrada (restrictiva vs convencional) y se comparó el número de días libres de ventilación mecánica invasiva posterior al procedimiento quirúrgico. Se realizó análisis descriptivo y comparativo, así como modelos de regresión de Cox para explorar la asociación entre variables clínicas y los días libres de ventilación.
Resultados: No se observaron diferencias estadísticamente significativas en los días libres de ventilación mecánica entre la estrategia restrictiva (4.04 días [3.37]) y la convencional
(4.22 días [2.79]); p=0.76. El sangrado intraoperatorio (HR: 1.00; IC 95%: 1.00–1.00; p=0.02) y la FiO2 (HR: 1.05; IC 95%: 1.00–1.10; p=0.01) mostraron asociación con una menor cantidad de días libres de ventilación mecánica.
Conclusiones: En esta cohorte de pacientes neuroquirúrgicos, la estrategia de fluidoterapia restrictiva o convencional no modificó los días libres de ventilación mecánica invasiva. Factores como el sangrado intraoperatorio y parámetros
ventilatorios como la FiO2 parecen tener mayor impacto en la duración del soporte ventilatorio y deben considerarse en la optimización del manejo perioperatorio.

Respiration, Artificial; Fluid Therapy; Neurosurgical Procedures; Brain Neoplasms; Cohort Studies

Zaida Solano Valencia.
Médico residente de Anestesiología. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

Eduardo Perez Lozano.
Médico pasante en investigación. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

Edwin Zoquiapa Galaviz.
Médico pasante en investigación. Centro Médico Nacional, Hospital de Especialidades “La Raza”. Ciudad de México, México.

  1. Ryu T. Fluid management in patients undergoing neurosurgery. Anesth Pain Med (Seoul). 2021 Jul;16(3):215-224. doi: 10.17085/apm.21072.
  2. Hourmant Y, Huard D, Demeure Dit Latte D, Bouras M, Asehnoune K, Pirrachio R, Roquilly A. Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2023 Apr;42(2):101177. doi: 10.1016/j.accpm.2022.101177.
  3. ommasino C, Picozzi V. Volume and electrolyte management. Best Pract Res Clin Anaesthesiol. 2007 Dec;21(4):497-516. doi:10.1016/j.bpa.2007.07.002.
  4. Frisvold S, Coppola S, Ehrmann S, Chiumello D, Guérin C. Respiratory challenges and ventilatory management in different types of acute brain-injured patients. Crit Care. 2023 Jun 23;27(1):247. doi: 10.1186/s13054-023-04532-4.
  5. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al; Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003 Nov;238(5):641-8. doi: 10.1097/01.sla.0000094387.50865.23.
  6. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al; Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018 Jun 14;378(24):2263-2274. doi: 10.1056/NEJMoa1801601.
  7. Wrzosek A, Jakowicka-Wordliczek J, Zajaczkowska R, Serednicki WT, Jankowski M, Bala MM, Swierz MJ, et al. Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery. Cochrane Database Syst Rev. 2019 Dec 12;12(12):CD012767. doi: 10.1002/14651858.CD012767.pub2.
  8. Yang TX, Tan AY, Leung WH, Chong D, Chow YF. Restricted Versus Liberal Versus Goal-Directed Fluid Therapy for Non-vascular Abdominal Surgery: A Network Meta-Analysis and Systematic Review. Cureus. 2023 Apr 28;15(4):e38238. doi: 10.7759/cureus.38238.
  9. Serpa Neto A, Deliberato RO, Johnson AEW, Bos LD, Amorim P, Pereira SM, et al; PROVE Network Investigators. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018 Nov;44(11):1914-1922. doi: 10.1007/s00134-018-5375-6.
  10. Dąbrowski W, Woodcock T, Rzecki Z, Malbrain MLNG. The use of crystalloids in traumatic brain injury. Anaesthesiol Intensive Ther. 2018;50(2):150-159. doi: 10.5603/AIT.a2017.0067.
  11. Esteban-Zubero E, García-Muro C, Alatorre-Jiménez MA. The Role of Fluid Therapy in Traumatic Brain Injury. DUNCAN LOWELLT, ed. Advances in Health and Disease. Vol 57. S.l.:NOVA SCIENCE; 2022.
  1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct 20;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD.
  1. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84. doi:10.1159/000339789.
  2. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009 Nov;41(4):1149-60. doi:10.3758/BRM.41.4.1149.
  3. Lindenblatt N, Park S, Alsfasser G, Gock M, Klar E. Intraoperative flüssigkeitstherapie bei pankreasresektionen–die sicht des chirurgen [Intraoperative fluid management in pancreatic resections–the surgeon’s view]. Zentralbl Chir. 2008 Apr;133(2):168-75. German. doi: 10.1055/s-2008-1004745.
  4. Han JW, Oh AY, Seo KS, Na HS, Koo BW, Lee YJ. Comparison of intraoperative basal fluid requirements in distal pancreatectomy: Laparotomy vs. laparoscopy: A retrospective cohort study. Medicine (Baltimore). 2017 Nov;96(47):e8763. doi:10.1097/MD.0000000000008763.
  5. Serpa Neto A, Deliberato RO, Johnson AEW, Bos LD, Amorim P, Pereira SM, et al; PROVE Network Investigators. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018 Nov;44(11):1914-1922. doi: 10.1007/s00134-018-5375-6.
  6. Frisvold S, Coppola S, Ehrmann S, Chiumello D, Guérin C. Respiratory challenges and ventilatory management in different types of acute brain-injured patients. Crit Care. 2023 Jun 23;27(1):247. doi: 10.1186/s13054-023-04532-4.
[1] Zaida Solano Valencia, Eduardo Perez Lozano, and Edwin Zoquiapa Galaviz. 2026. Comparación de los días libres de ventilación mecánica invasiva con la estrategia de fluidoterapia restrictiva vs convencional en pacientes postoperados de neurocirugía: cohorte retrospectivo. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 59–69. https://doi.org/10.58281/ccem060126-invst-03
PDF
HTML

Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

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