Departments of Anesthesiology and Biomedical Engineering, Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, UVA Enhanced Recovery after Surgery (ERAS) Program, University of Virginia School of Medicine, Charlottesville, VA USA.
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710 USA.
Perioper Med (Lond). 2016 Sep 17;5:24. doi: 10.1186/s13741-016-0049-9. eCollection 2016.
Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients undergoing colorectal surgery. There is some controversy about the adoption of specific elements in enhanced recovery "bundles" because the relative importance of different components of ERPs is hard to discern (a consequence of multiple simultaneous changes in clinical practice when ERPs are initiated). There is evidence that specific approaches to fluid management are better than alternatives in patients undergoing colorectal surgery; however, several specific questions remain.
In the "Perioperative Quality Initiative (POQI) Fluids" workgroup, we developed a framework broadly applicable to the perioperative management of intravenous fluid therapy in patients undergoing elective colorectal surgery within an ERP.
We discussed aspects of ERPs that impact fluid management and made recommendations or suggestions on topics such as bowel preparation; preoperative oral hydration; intraoperative fluid therapy with and without devices for goal-directed fluid therapy; and type of fluid.
强化康复可被视为一种全面的方法，以改善接受大手术的患者的有意义的结果。在接受结直肠手术的患者中，支持强化康复途径（ERPs）的证据非常有力。由于 ERPs 启动时临床实践中同时发生了多种变化，因此 ERPs 中“捆绑包”的特定元素的采用存在一些争议（这是因为 ERPs 中“捆绑包”的特定元素的采用存在一些争议（这是因为 ERPs 中“捆绑包”的特定元素的采用存在一些争议（这是因为 ERPs 中“捆绑包”的特定元素的采用存在一些争议（这是因为 ERPs 中“捆绑包”的特定元素的采用存在一些争议），不同 ERP 组件的相对重要性难以辨别。有证据表明，在接受结直肠手术的患者中，特定的液体管理方法优于替代方法；然而，仍有几个具体问题悬而未决。
在“围手术期质量倡议（POQI）液体”工作组中，我们开发了一个广泛适用于在 ERP 中接受择期结直肠手术的患者围手术期静脉输液治疗管理的框架。
我们讨论了影响液体管理的 ERPs 方面，并就肠道准备；术前口服补液；有无目标导向液体治疗设备的术中液体治疗；以及液体类型等主题提出了建议或建议。
