Improving intraoperativefluid management

Complications from overhydration1,2,3:

• pulmonaryedema• respiratoryfailure• pneumonia• gastrointestinaledema,• decreasedmotility• ileus• anastomotic dehiscence in colorectalsurgery

Goal: To conduct a quality improvementprojectseekingtooptimizeintraoperativefluidmanagementbyestablishing currentpracticesinordertoidentifywaystochangeanesthesiologistbehaviour.

Hypothesis:Anesthesiologistseitherdonotfillinthetotalvolumeoffluidadministeredontheanesthesiarecord,ordonotfillouttherecordaccurately.

References

1. Arieff, A. I. (1999). Fatal Postoperative Pulmonary Edema: Pathogenesis and Literature Review, (1), 1371–1377. http://doi.org/10.1378/chest.115.5.1371

2. Ferrara, N. (2002). Pathophysiology and Clinical Implications of, 89(4), 89–108.3. Nisanevich, V., Felsenstein, I., Almogy, G., Weissman, C., Einav, S., & Matot, I. (2005). Effect of Intraoperative Fluid Management

on Outcome after Intraabdominal Surgery. Anesthesiology, 103(1), 25–32. http://doi.org/10.1177/1531003506018001294. Brandstrup, B., Tønnesen, H., Beier-Holgersen, R., Hjortsø, E., Ørding, H., Lindorff-Larsen, K., … Pott, F. (2003). Effects of Intra-

venous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid Regimens. Annals of Surgery, 238(5), 641–648. http://doi.org/10.1097/01.sla.0000094387.50865.23

5. Abraham-Nordling, M., Hjern, F., Pollack, J., Prytz, M., Borg, T., & Kressner, U. (2012). Randomized clinical trial of fluid restric-tion in colorectal surgery. British Journal of Surgery, 99(December 2004), 186–191. http://doi.org/10.1002/bjs.7702

Implications: If we determine how anes-thesiologistsarefillingoutthefluidadmin-istrationsectionof theanesthesiarecord,thenwecanassesswhethercurrentmeth-odsandbehaviourslendthemselvestoin-tervention (i.e.: implementing goal-direct-edfluid therapy)orhowwe can create apositive environment for change. Thus, anumberofcomplications fromoverhydra-tioncanbereduced.