Kravets O. Optimization of perioperative infusion therapy in urgent surgical diseases of abdomen

The dynamics of water sector indicators, hemodynamics, inflammation and homeostasis were analyzed in 314 patients with acute abdominal pathology of moderate and high surgical risk with various modes of perioperative infusion therapy. Independent risk factors for postoperative complications were identified: extracellular fluid and interstitial volumes, shock index, Peripheral Perfusion Index, and serum intreleukin 6 concentration. A restrictive mode of perioperative infusion therapy was introduced (for 1 day - 2.7 (0.4) ml/kg/h, in the future– 1,6 (0,1) – 1,5 (0,1) ml / kg / h) with the distribution of its volume according to the stages of infusion treatment. This reduces the manifestations of multiple organ dysfunction and improves the final results of treatment in patients regardless of the degree of surgical risk: reduces the duration of postoperative gastrostasis, accelerates the onset of enteral nutrition, reduces the development of postoperative prolonged ileus and fully limits the threat of intraabdominal hypertension syndrome; reduces the incidence of acute stage I kidney damage (AKIN KDIGO scale), surgical complications of all degrees of severity, and pulmonary complications. With an average surgical risk, this speeds up the treatment time in ICU by 1.5 (0.8) days less, in the hospital – by 2.8 (3.1) days less, reduces mortality by 4,0 %. At high surgical risk, this reduces the duration of treatment in ICU by 1.9 (0.8) days less and in hospital – by 2.7 (1.1) days less.