J. E. Baker1, G. Katsaros1, G. E. Martin1, C. Wakefield1, A. T. Makley1, M. D. Goodman1 1University Of Cincinnati,Surgery,Cincinnati, OH, USA
Introduction: Perioperative fluid management during surgery for trauma remains a debated issue as the exact quantity and type of fluid replacement is not well established. Several studies have observed a decrease in postoperative complications following major abdominal surgery when a limited perioperative fluid regimen is utilized; however, few studies have investigated outcomes resulting from the type of crystalloid used during trauma laparotomy. In this analysis, we sought to identify 1) which crystalloids were utilized most commonly during trauma laparotomy, 2) whether transfusion was associated with the amount and of crystalloid used, and 3) whether crystalloid use affected markers of resuscitation.
Methods: A retrospective review of 504 patients who underwent laparotomy for abdominal trauma between 2014-2016 was performed. Medical records were reviewed to establish estimated blood loss (EBL); postoperative laboratory values; anesthesia provider present; and volume and type of crystalloid and blood products infused during trauma laparotomy. Correlation analysis was performed to investigate relationships between the amount of crystalloid infused and EBL as well as between the amount of crystalloid received and the number of blood products transfused. The relationship between the amount and type of each crystalloid received and post-operative markers of resuscitation was investigated.
Results: Lactated Ringer’s was the most commonly used crystalloid, followed by normal saline and normosol (50.7% vs. 34.7% vs. 14.6% of all crystalloid infused, respectively). During all laparotomies, 1.9% of patients received no crystalloid, 38.5% received one type of crystalloid, 47.9% received 2 different types of crystalloid, and 11.6% received 3 different types of crystalloid. A total of 50.3% of patients received one or more units of packed red blood cells (pRBCs) during laparotomy. A moderate correlation was identified between the amount of crystalloid received and time spent in the OR, and was similar amongst anesthesia providers (resident, r=0.65; CRNA, r=0.62). No correlation was observed between the amount of crystalloid received and EBL (r=0.09). There was no correlation between the amount of crystalloid and the number of pRBCs (r=0.02); this remained true for those patients who underwent massive transfusion. For those who received more than 5 units of pRBCs, there was a moderate correlation between the number of different crystalloids received and the volume of crystalloid received (r=0.695). There was no correlation between any type of crystalloid received and postoperative sodium, lactate, or pH.
Conclusion: A wide variation was observed in the amounts and types of crystalloids administered intraoperatively for patients undergoing laparotomy for trauma. Interestingly, the amount of crystalloid infused only correlated with time in the OR rather than EBL. Furthermore, the type of crystalloid received did not influence postoperative markers of resuscitation.