Improvement of preoperative infusion therapy in patients with acute large bowel obstruction

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OBJECTIVE

To improve preoperative management of patients with acute large bowel obstruction.

MATERIAL AND METHODS

We analyzed certain functional parameters in patients with acute large bowel obstruction before and after preoperative infusion therapy. Patients were divided into 2 groups depending on composition, volume and duration of infusion therapy. The study involved 56 patients (35 women and 21 men) with malignant acute large bowel obstruction. Age of patients ranged from 50 to 88 years. Mean baseline APACHE II and SOFA scores were 9±0.1 and 18±0.2, respectively. Mean period between clinical manifestation of acute large bowel obstruction and admission to the hospital was 50.2 hours (range 48-76).

RESULTS

Analysis of central hemodynamics showed that patients with acute large bowel obstruction had hypodynamic circulation (decrease of stroke volume index, mean blood pressure and peripheral vascular resistance) due to hypovolemia and accompanied by impaired oxygen transport. Any variant of preoperative fluid therapy does not provide radical correction of hemodynamic disorders, since there are time limitations for therapy. The modified infusion therapy increased stroke volume index from 22.5±2.9 to 32±3.9 ml/m² (by 42.2%). In case of conventional preoperative preparation, stroke volume index increased from 23.2±1.6 to 25.2±1.8 ml/m²(by 8.6%).

CONCLUSION

Preoperative infusion therapy with modern balanced crystalloid solutions under control of passive leg raising test, prolongation of therapy and increase of infusion volume can achieve better results compared to traditional preoperative preparation. More effective correction of functional changes, as well as lower postoperative mortality and incidence of re-laparotomy follow this approach.

Keywords:

large bowel obstruction

passive leg raising test

fluid therapy

Authors:

Neymark M.I.

Altai State Medical University

ORCID: 0000-0001-9135-6392

Zhukov A.S.

Regional Clinical Hospital for Emergency Care

Received:

05.06.2021

Accepted:

06.11.2021

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