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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Clinical practice guide for the choice of perioperative volume-restoring fluid i...
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Vol. 63. Issue 1.
Pages 29-47 (January 2016)
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Vol. 63. Issue 1.
Pages 29-47 (January 2016)
Special article
DOI: 10.1016/j.redare.2015.11.001
Clinical practice guide for the choice of perioperative volume-restoring fluid in adult patients undergoing non-cardiac surgery
Guía de práctica clínica para la elección del fluido de restauración volémica perioperatoria en los pacientes adultos intervenidos de cirugía no cardiaca
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M. Basoraa,
Corresponding author
mbasora@clinic.ub.es

Corresponding author.
, M.J. Colominab, V. Moralc, M.S. Asuero de Lisd, E. Boixe, J.L. Joverf, J.V. Llaug, M.P. Rodrigoh, J. Ripollési, J.M. Calvo Vecinoj
a Anestesiología y Reanimación, Hospital Clínic, Barcelona, Spain
b Anestesiología y Reanimación, Hospital Universitario Vall d’Hebron, Barcelona, Spain
c Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, Spain
d Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, Spain
e Anestesiología y Reanimación, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
f Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoi, Alicante, Spain
g Anestesiología y Reanimación, Hospital Clínico Universitario, Valencia, Spain
h Anestesiología y Reanimación, Hospital de Basurto, Bilbao, Spain
i Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain
j Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain
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Tables (13)
Table 1. Indications for fluid management according to clinical situation5
Table 2. Characteristics of the principle crystalloids used.
Table 3. Characteristics of the principle colloids used.
Table 4. Characteristics of studies used to compare the safety of crystalloids and colloids in volume replacement.
Table 5A. Summary of findings and quality of evidence: albumin vs crystalloids (question 1).
Table 5B. Summary of findings and quality of evidence: hydroxyethyl starch (HES) MP 130 vs crystalloids (question 1).
Table 5C. Summary of findings and quality of evidence: modified gelatin vs crystalloids (question 1).
Table 6. Characteristics of studies used to compare the safety of crystalloids and colloids in volume replacement.
Table 7A. Summary of findings and quality of evidence table: albumin vs hydroxyethyl starch (HES) (question 2).
Table 7B. Summary of findings and quality of evidence: modified gelatin vs hydroxyethyl starch (HES) (question 2).
Table 7C. Summary of findings and quality of evidence table: comparison 3: HES 130/0.42 vs HES 130/0.4 (question 2).
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Abstract

The present clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience.

Keywords:
Fluid therapy
Perioperative period
Colloids
Clinical practice guide
Surgery
Resumen

Esta Guía de Práctica Clínica responde a preguntas clínicas sobre seguridad en la elección de fluido (cristaloide, coloide o Hidroxietilalmidón 130) en pacientes que precisan restauración volémica en el periodo perioperatorio de cirugía no cardiaca. A partir del resumen de la evidencia, se elaboraron las recomendaciones siguiendo la metodología GRADE. En esta población se sugiere la fluidoterapia basada en la administración de cristaloides, (recomendación débil, calidad de la evidencia baja). En las situaciones en las que la restauración volémica no se alcance sólo con cristaloides, se sugiere utilizar coloides sintéticos (Hidroxietilalmidón 130 o gelatina fluida modificada) en lugar de Albúmina 5% (recomendación débil, calidad de la evidencia baja). La elección y dosificación de coloide deberán basarse en las características del producto, comorbilidad del paciente y experiencia del anestesiólogo.

Palabras clave:
Fluidoterapia
Periodo perioperatorio
Coloides
Guía de práctica clínica
Cirugía

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