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Survey of intravenous fluid maintenance therapy for surgical patients in the UK
Critical Care volume 10, Article number: P185 (2006)
Surgical patients receive various intravenous maintenance fluids after major surgical procedures. Usually these fluids are prescribed by most junior surgical trainees with different levels of experience. We surveyed intravenous maintenance fluid therapy for post major abdominal surgery patients among surgical trainees in London, UK.
To assess the current intravenous fluid optimisation practice among surgical senior house officers (SHOs), after major abdominal operations.
Surgical SHOs were contacted by telephone. The answers for a set of questions regarding their level of experience, including intensive care training, and choice of intravenous fluids for major abdominal surgical procedures were recorded on a paper. The telephone interview was done by a single member, for all SHOs, and data were analysed.
One hundred and fifty surgical SHOs were contacted (response rate 100%) and the results are summarised in Tables 1 and 2. The majority (67%) of the surgical trainees did not have previous formal intensive care training. More than one-half of the SHOs (51%) preferred 0.9% sodium chloride (normal saline) as their first-choice intravenous maintenance fluid. When asked regarding awareness of central venous saturation (ScvO2) monitoring for fluid optimisation, only 44% of the trainees regularly used ScvO2 as a guide to fluid therapy. Only 27% of the surgical SHOs are aware of goal-directed therapy for surgical patients. The SHOs who had previous intensive care experience had better knowledge of ScvO2 monitoring (88%) and goal-directed therapy.
Sixty-one per cent of trainees monitor blood electrolytes only when they recognise or anticipate complications.
Currently there is no clear recommendation by the surgical or intensive care bodies regarding minimal formal intensive care training for surgical trainees in the UK. In spite of increasing evidence of hyperchloremic metabolic acidosis, caused by use of normal saline as maintenance fluid in surgical patients, the majority of the surgical SHOs prefer normal saline as the first-choice maintenance fluid. Introduction of regular intensive care teaching should be part of the curriculum for surgical training to improve the care of critically ill surgical patients in the wards.
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Raobaikady, R., Gikas, P. Survey of intravenous fluid maintenance therapy for surgical patients in the UK. Crit Care 10, P185 (2006). https://doi.org/10.1186/cc4532
- Intravenous Fluid
- Maintenance Fluid
- Fluid Optimisation
- Senior House Officer
- Hyperchloremic Metabolic Acidosis