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About Fluid Day Study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "121" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.J. Colomina, P. Guilabert, J. Ripollés-Melchor, J.L. Jover, M. Basora, J.V. Llau, C. Casinello, R. Ferrandis" "autores" => array:9 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Colomina" "email" => array:2 [ 0 => "mjcolomina@bellvitgehospital.cat" 1 => "mjcolomina@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Guilabert" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Ripollés-Melchor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "Jover" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Basora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "J.V." "apellidos" => "Llau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "C." "apellidos" => "Casinello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "R." "apellidos" => "Ferrandis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:1 [ "colaborador" => "as components of the Executive Committee of the Fluid Day Project" ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitari Bellvitge, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy (Alicante), Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitari Dr. Peset, Valencia, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Miguel Servet, Zaragoza, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estado actual de la fluidoterapia en el paciente quirúrgico en nuestro medio. A propósito del estudio <span class="elsevierStyleItalic">Fluid Day</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to the guidelines of the Spanish Society of Anesthesiology, Critical Care and Pain Management (SEDAR), “The aim of fluid management is to maintain the body's hydration status and tissue perfusion at optimum levels, managing electrolyte balance to guarantee the timely replacement of fluids, preventing adverse effects, and ultimately, achieving a balance between tissue-level oxygen supply and demand”.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In clinical practice, however, anaesthesiologists encounter various practical issues that require decisions in order to optimize fluid therapy throughout the perioperative period.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the main issues is currently the volume of fluids administered.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3–5</span></a> Under normal circumstances, the patient's preoperative hydration and volume status are not known. In addition, the best way to achieve and monitor preoperative fluid replacement targets has yet to be established, and many targets that are theoretically possible cannot be monitored in practice. The main objective is nearly always to optimize cardiac preload. It is important to emphasize that optimization does not necessarily mean maximization, despite being frequently interpreted in this way.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> In stable surgical patients, fluid exchange-related physiological changes are usually minimal, so replacement should also be kept to a minimum. Even so, there is clear evidence that fluid replacement strategies differ between anaesthesiologists and surgeons in the same centre, and between different hospitals, and are mainly determined by “habit” and not by the real needs of the patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Fluids administration methods also vary greatly.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6,7</span></a> Indications for fluids and control of the effects of fluid replacement are not standardized, and can therefore lead to inter-professional variations. Historically, administration of intravenous fluids to treat hypovolaemia has been guided by measuring pulse rate, blood pressure, and central venous pressure. However, this approach lacks the sensitivity and specificity needed to identify plasma volume deficit, and leads to inappropriate, and in many cases excessive, fluid administration.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> Although changes over time in heart rate, blood pressure and central venous pressure are the main markers of the effect of fluid administration on vascular filling, they are influenced by other factors and do not exhibit a linear relationship with cardiac output or tissue perfusion. Therefore, absolute values of these parameters may not give a reliable picture of the need for intravenous fluid administration.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> The introduction of minimally invasive techniques, such as transoesophageal Doppler or pulse contour analysis for measuring stroke volume and cardiac output, has made allowed clinicians to adjust fluid requirements more accurately to the needs of each patient. Clinical trials have shown that fluid therapy guided by measurements of dynamic parameters gives significantly better clinical outcomes than those based on traditional monitoring methods.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">8,9</span></a> This beneficial effect is probably related to prompt measures to adjust fluid administration to the specific requirements of the patient, instead of following fixed fluid replacement rules.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> The individual parameters used to guide fluid therapy are measures of cardiovascular function, and vary in each monitoring system.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> In practice, goal directed fluid therapy (GDFT) involves the repeated intravenous administration of small boluses of fluids, often colloids, until certain a target or plateau has been reached. A baseline infusion of crystalloids is usually administered. Several randomized trials and subsequent meta-analyses in various surgical settings have that GDFT confers clear clinical benefits, such as reduction in postoperative morbidity and length of hospital stay compared to traditional and liberal fluid therapy.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9–11</span></a> In addition, recent guidelines recommend using other parameters to control macro- and microcirculation.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> However, this approach is still not widespread in high-risk surgical patients.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6,12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This situation, coupled with the need to understand and evaluate usual surgical practice in Spain, has prompted the Haemostasis, Transfusion Medicine and Fluid Therapy division of SEDAR to develop the Fluid Day project.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fluid Day is a project carried out by SEDAR to evaluate fluid management strategies used by anaesthesiologists in adult patients during the perioperative period of scheduled and urgent surgery. The project will also evaluate the impact of the administration of the different types of fluids and blood products, fluid management monitoring strategies, the use of vasoactive support, and the implementation of GDTF protocols.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Fluid Day project will provide information about perioperative fluid therapy in Spain, detailing how anaesthesiologists administer each type of fluid during both the intraoperative and postoperative period, and will give insight into the factors determining these choices. Fundamentally, and in practical terms, our aim is to answer the “4 Ds”:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Drug</span>: type of solution infused. There is still no general consensus on the best solution to use in each surgical scenario and patient.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dose</span>: volume of solution needed. This will depend on the clinical scenario and the patient.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Duration</span>: how long to administer fluids, and the best method.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Disconnection or termination</span>: the best moment to stop fluid administration.</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">This is a multicentre, observational, prospective study that will take place on 2 alternate days in all the Spanish hospitals that have chosen to participate. The study will collect data on the fluid therapy administered to real patients by anaesthesiologists on duty on these dates and during a maximum follow-up period of 24<span class="elsevierStyleHsp" style=""></span>h, provided the patient is supervized by the anaesthesiology service.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Conducting research in Spain is no easy task. Unfortunately, we anaesthesiologists are relatively unaccustomed to research, because our work has always been fundamentally hand-on. There is a growing demand for anaesthesiologists in all hospitals and all specialties, and this makes it particularly difficult to devote part of our time to anything other than purely care-related activities. The lack of a research culture, and consequently research training, and the pressures of work in our field are the main barriers in this respect. However, on the bright side, a growing number of anaesthesiologists are willing to participate in multicentre clinical studies in order to contribute to the evolution of anaesthesiology; proof of this new trend has been the positive response to this project More than one hundred hospitals have joined the project, and we believe that this is an example of how scientific societies should promote the advancement of science and help create a research culture.</p><p id="par0070" class="elsevierStylePara elsevierViewall">For all these reasons, we believe that the effort involved in carrying out a project of such magnitude is amply justified, and we encourage all anaesthesiologists to continue in this line.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Colomina MJ, Guilabert P, Ripollés-Melchor J, Jover JL, Basora M, Llau JV, et al. 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