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1、CONSENSUS STATEMENTOpen AccessAmerican Society for Enhanced Recovery(ASER) and Perioperative Quality Initiative(POQI) joint consensus statement onperioperative fluid management within anenhanced recovery pathway for colorectalsurgeryRobert H. Thiele1, Karthik Raghunathan2, C. S. Brudney3, Dileep N.
2、Lobo4, Daniel Martin5,6, Anthony Senagore7,Maxime Cannesson8, Tong Joo Gan9, Michael Monty G. Mythen10, Andrew D. Shaw11, Timothy E. Miller12*and For the Perioperative Quality Initiative (POQI) I WorkgroupAbstractBackground: Enhanced recovery may be viewed as a comprehensive approach to improving me
3、aningfuloutcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) isstrong in patients undergoing colorectal surgery. There is some controversy about the adoption of specificelements in enhanced recovery “bundles” because the relative importance of differen
4、t components of ERPsis hard to discern (a consequence of multiple simultaneous changes in clinical practice when ERPs areinitiated). There is evidence that specific approaches to fluid management are better than alternatives inpatients undergoing colorectal surgery; however, several specific questio
5、ns remain.Methods: In the “Perioperative Quality Initiative (POQI) Fluids” workgroup, we developed a framework broadlyapplicable to the perioperative management of intravenous fluid therapy in patients undergoing electivecolorectal surgery within an ERP.Discussion: We discussed aspects of ERPs that
6、impact fluid management and made recommendations orsuggestions on topics such as bowel preparation; preoperative oral hydration; intraoperative fluid therapy withand without devices for goal-directed fluid therapy; and type of fluid.Keywords: Enhanced recovery pathway, Enhanced recovery, Fluids, Col
7、orectal surgery, Crystalloids, Colloids,Goal-directed fluid therapy, Carbohydrate drink, Hemodynamics* Correspondence: timothy.miller2duke.edu12Division of General, Vascular and Transplant Anesthesia, American Societyfor Enhanced Recovery, Duke University Medical Center, Durham, NC 27710,USAFull lis
8、t of author information is available at the end of the article The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http:/creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andrepro
9、duction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http:/creativecommons.org/publicdomain/zero/1.0/) applies to th
10、e data made available in this article, unless otherwise stated.Thiele et al. Perioperative Medicine (2016) 5:24 DOI 10.1186/s13741-016-0049-9Consensus statementsPrior to surgery1. We recommend unrestricted access to clear fluidsfor oral intake up to 2 h before the induction ofanesthesia to maintain
11、hydration while minimizingthe risk of aspiration.2. We recommend that the clear fluid used to maintainoral hydration contain at least 45 g of carbohydrateto improve insulin sensitivity (except in type Idiabetics due to their insulin deficiency state).We suggest that complex carbohydrate (e.g.,maltod
12、extrin) be used when available.3. We recommend that clinicians avoid administrationof intravenous fluids to replace preoperative “fluidlosses” in patients who received iso-osmotic bowelpreparation provided there was unrestricted intakeof clear fluids for up to 2 h before the inductionof anesthesia.
13、There is no evidence that iso-osmoticmechanical bowel preparation leads to adverseeffects on preoperative volume status.4. We recommend against the use of hyper-osmotic orhypo-osmotic bowel preparations prior to surgerysince there is no benefit relative to iso-osmoticbowel preparation and there may
14、be adverse effectson preoperative volume status.During and after surgery5. We recommend the application of a hemodynamicframework to guide clinical decision-making duringsurgery. We have developed such a framework andsuggest that the use of intraoperative goal-directedfluid therapy (GDFT) is likely
15、to be safe in themajority of patients undergoing major colorectalsurgery. GDFT has little risk, and the use ofadvanced hemodynamic monitoring equipmentmay enhance clinical decision-making whencompared with the use of conventional monitors.6. We suggest that the advanced hemodynamicmonitoring equipme
16、nt used to guide clinicaldecision-making intraoperatively be selected basedon a combination of surgical patient and institutionalfactors since such monitoring can minimize bothhypovolemia (by promoting therapy in volumeresponders) and hypervolemia (by restrictingtherapy in non-responders).7. We recommend that in isolation, intraoperativeoliguria should not trigger fluid therapy, as lowurine output is a normal physiologic responseduring surgery and anesthesia. We also recommendthat intraoperative
