News from Spain: FLUID DAY: How Spanish Anaesthetists understand fluid management

News from Spain: FLUID DAY: How Spanish Anaesthetists understand fluid management

  • issue 77

M Giménez-Milà
M J Colomina
gimimarc@gmail.com

‘Balanced solutions’, ‘Glycocalyx’, ‘Hypercloremic metabolic acidosis’, ‘Restrictive approach’, ‘fluid challenge’, and ‘Frank-Starling principles’ are all terms that apply to fundamental concepts and controversies regarding perioperative fluid management. Diving into all of them is beyond the scope of this article, but helps us contextualise the interest fluid therapyhas obtained in recent years.

Many of us would point towards Rivers and his Early goal-directed therapy in the treatment of severe sepsis and septic shock1 as one of the first promoters of fluid therapy research. Despite subsequent criticism, some of the bundle elements currently remain valid in the last Surviving Sepsis campaign guideline,2 such as crystalloid bolus administration of up to 30 ml/kg if hypotension or hyperlactacidaemia are present.

Fluid administration is no longer a trivial and irrelevant act and acquires a degree of therapy. Restoration of intravascular volume in order to compensate for perioperative losses and enhance organ perfusion are one of its main established objectives, while minimising side effects of fluid overload such as pulmonary and gastrointestinal complications, and length of stay.3 Many of the studies on fluid therapy focus the interest in either critical care or anaesthesia, with few obtaining data of the whole perioperative period including surgery and the first hours in critical care. Likewise, many clinical practice guidelines have been published by scientific societies in different countriesincluding different types of patients and surgeries, which could imply difficulties for their application in a daily clinical practice.4

In all of them, attempts have been made to establish recommendations on the type of fluid to be administered, the optimal quantity, and the adequate monitoring to guide it. But, most of them have included different types of patients and surgeries that have difficulties for their application in daily clinical practice.

With this background of knowledge and gaps of knowledge in literature, the Fluid Day Study is born. Investigators from the Spanish Society of Anaesthesia (SEDAR) designed a 2-day study to understand perioperative fluid practice in patients having surgery in hospitals in Spain.5 A clinical-based, prospective, and observational study is proposed with the objective of understanding real-life fluid management. Type of fluid and quantity given in the operating theatre and the first 24 h in critical care will be collected.6 The results of this study will provide us with data for a better understanding of current management of fluid therapy in the surgical patient in Spain, enabling evaluation of compliance with international guidelines but most importantly starting a quality improvement strategy on fluid therapy.

Although we would like to offer you prompt results, recruitment has recently been concluded, 132 centres across the country and more than 1800 investigators participated. Data analysis has been started and results should be available soon.

We believe the Fluid Day Study is an example of collaborative research between different centres with the objective to answer a clinical question that could in the future be applied in clinical practice. Be ready to learn perioperative fluid practice amongst Spanish anaesthetists!

References

1. Rivers E, Nguyen B, Havstad S, et al. N Engl J Med2001;345:1368–77.

2. Levy MM, Evans LE, Rhodes A. Crit Care Med2018;46(6):997-1000.

3. Hahn RG. Anaesthesiol Intensive Ther2015;47(5):449-56.

4. Lira A, Pinsky MR. Ann Intensive Care2014;4:38.

5. Colomina MJ, Guilabert P, Ripollés-Melchor J, et al. Rev Esp Anestesiol Reanim2019;66(3):119-21.

6. ClinicalTrials.gov Identifier: NCT03630744