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Population-based volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy.

ABSTRACT: In order to maintain stable blood pressure and heart rate during surgery, anesthesiologists need to administer the appropriate amount of fluid with appropriate fluid type to the patient, then quantifying how fluid is distributed and eliminated from the body is useful for establishing a fluid administration strategy. In this study we characterized the volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy. When propofol and remifentanil reached a pseudosteady state at the target concentration and blood pressure was stabilized following surgical stimulation, enrolled patients were administered 1000?mL of Ringer's lactate solution for 20?min, followed by continuous infusion at a rate of 6?mL/kg/h until the time of the last blood collection for volume kinetic analysis. Arterial blood samples were collected to measure the hemoglobin concentration at different time points. The change in hemoglobin-derived plasma dilution induced by the administration of Ringer's lactate solution was evaluated by nonlinear mixed effects modeling. Three hundred and twenty-three plasma dilution data points from 27 patients were used to determine the pharmacokinetic characteristics of Ringer's lactate solution. A two-volume model best described the pharmacokinetics of Ringer's lactate solution. The mean arterial pressure (MAP) and body weight (WT) were significant covariates for the elimination clearance (k_r) and central volume of distribution at baseline (V_c0), respectively. The parameter estimates were as follows: k_r (mL/min)?=?124?+?(MAP/70)^14.2, V_c0 (mL)?=?0.95?+?3440?×?(WT/63), V_t0 (mL)?=?2730, and k_t (mL/min)?=?181. A higher MAP was associated with a greater elimination clearance and, consequently, less water accumulation in the interstitium. As body weight increases, volume expansion in the blood vessels increases.

SUBMITTER: Lee JH

PROVIDER: S-EPMC6786407 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Population-based volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy.

Lee Joo-Hyun JH Choo Yeong-Jin YJ Lee Yong-Hun YH Rhim Jin-Ho JH Lee Soo-Han SH Choi Byung-Moon BM Oh Sung-Tae ST Choi Kyu-Taek KT Noh Gyu-Jeong GJ

Acta pharmacologica Sinica 20181016 5

In order to maintain stable blood pressure and heart rate during surgery, anesthesiologists need to administer the appropriate amount of fluid with appropriate fluid type to the patient, then quantifying how fluid is distributed and eliminated from the body is useful for establishing a fluid administration strategy. In this study we characterized the volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy. When propofol and remifentanil reached a pseudosteady state a ...[more]

PMID: 30327545

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Project description:ObjectivesNormal saline (NS) and Ringer's lactate (RL) are the most common crystalloids used for fluid therapy. Despite evidence of possible harm associated with NS (eg, hyperchloremic metabolic acidosis, impaired kidney function and death), few large multi-centre randomised trials have evaluated the effect of these fluids on clinically important outcomes. We conducted a pilot trial to explore the feasibility of a large trial powered for clinically important outcomes.DesignFLUID was a pragmatic pilot cluster randomised cross-over trial.SettingFour hospitals in the province of Ontario, Canada PARTICIPANTS: All hospitalised adult and paediatric patients with an incident admission to the hospital over the course of each study period.InterventionsA hospital wide policy/strategy which stocked either NS or RL throughout the hospital for 12 weeks before crossing over to the alternate fluid for the subsequent 12 weeks.Primary and secondary outcome measuresThe primary feasibility outcome was study fluid protocol adherence. Secondary feasibility outcomes included time to Research Ethics Board (REB) approval and trial initiation. Primary (composite of death or re-admission to hospital in first 90 days of index hospitalisation) and secondary clinical outcomes were analysed descriptively.ResultsAmong 24 905 included patients, mean age 59.1 (SD 20.5); 13 977 (56.1%) were female and 21 150 (85.0%) had medical or surgical admitting diagnoses. Overall, 96 821 L were administered in the NS arm, and 78 348 L in the RL arm. Study fluid adherence to NS and RL was 93.7% (site range: 91.6%-98.0%) and 79.8% (site range: 72.5%-83.9%), respectively. Time to REB approval ranged from 2 to 48 days and readiness for trial initiation from 51 to 331 days. 5544 (22.3%) patients died or required hospital re-admission in the first 90 days.ConclusionsThe future large trial is feasible. Anticipating and addressing logistical challenges during the planning stages will be imperative.Trial registration numberNCT02721485.

Dataset Information

Population-based volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy.

Publications

Population-based volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy.

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