Effect of Volume and Type of Fluid on Postoperative Incidence of Respiratory Complications and Outcome (CRC-Study)

Massachusetts General Hospital104,000 enrolled

Overview

Intraoperative intravenous fluid management practice varies greatly between anesthesiologists. Postoperative fluid based weight gain is associated with major morbidity. Postoperative respiratory complications are associated with increased morbidity, mortality and hospital costs. The literature shows conflicting data regarding intraoperative fluid resuscitation volume. No large-scale studies have focused on intraoperative fluid management and postoperative respiratory dysfunction. Hypotheses: Primary - Liberal intraoperative fluid resuscitation is associated with an increased risk of 30 day mortality Secondary - Liberal intraoperative fluid resuscitation is associated with increased likelihood of postoperative respiratory failure, pulmonary edema, reintubation, atelectasis, acute kidney injury and peri-extubation oxygen desaturation.

Study Type

OBSERVATIONAL

Enrollment

104,000

Conditions

Respiratory Failure Acute Respiratory Failure Requiring Reintubation Pulmonary Edema Pneumonia Hypoxia Acute Kidney Injury

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Ages 18 upwards * Tracheally intubated at the beginning of the procedure and extubated at the end of the procedure Exclusion Criteria: * Cases where the subject had additional surgeries within the previous four weeks * Ages under 18

Outcomes

Primary Outcomes

Mortality

Mortality within 30 days of surgery

Time frame: within 30 days after surgery

Secondary Outcomes

Postoperative pulmonary complications

The incidence of a diagnosis of pneumonia, respiratory failure, atelectasis or pulmonary edema within 3 days after extubation in the operating room. Cases where these diagnoses were present on the day before surgery were not counted.

Time frame: 3 days after surgery

Acute Kidney Injury

A Creatinine increase of \>0.3mg/dl or 50% from baseline (Creatinine value closest recorded to surgery but within 30 days of surgery) to maximum value measured within 48 hours postoperatively or an ICD-9 diagnosis of AKI within 7 days of surgery but not within 30 days prior to surgery

Time frame: within 48 hours of surgery

Post-extubation oxygen desaturation

One or more minutes with a blood oxygen saturation below 90% during the first ten minutes after extubation

Time frame: within the first 10 minutes after extubation