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Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.
Keywords
Fluid Management, Goal Directed Fluid Management, Goal Directed Fluid Therapy, NPO
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CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Editorial decision: Accept
On 28 Sep, 2019
Editor assigned
On 27 Sep, 2019
Submission checks complete
On 26 Sep, 2019
Editor invited
On 26 Sep, 2019
No comments provided
Editorial decision: Minor revision
On 26 Sep, 2019
No comments provided
Editorial decision: Minor revision
On 19 Sep, 2019
Editor assigned
On 17 Sep, 2019
Submission checks complete
On 16 Sep, 2019
Editor invited
On 16 Sep, 2019
Version 2
Posted 18 Sep, 2019
No comments provided
Review #1 received
Received 06 Sep, 2019
Editorial decision: Minor revision
On 06 Sep, 2019
Reviewer #2 agreed
On 31 Aug, 2019
Editor assigned
On 30 Aug, 2019
Reviewers invited
Invitations sent on 30 Aug, 2019
Reviewer #1 agreed
On 30 Aug, 2019
Submission checks complete
On 29 Aug, 2019
Editor invited
On 29 Aug, 2019
No comments provided
Review #2 received
Received 28 Jul, 2019
Editorial decision: Major revision
On 28 Jul, 2019
Review #1 received
Received 21 Jul, 2019
Reviewer #1 agreed
On 17 Jul, 2019
Reviewer #2 agreed
On 17 Jul, 2019
Submission checks complete
On 17 Jul, 2019
Editor assigned
On 17 Jul, 2019
Reviewers invited
Invitations sent on 17 Jul, 2019
Editor invited
On 16 Jul, 2019
First submitted
On 08 Jul, 2019
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Subject Areas
Anesthesiology & Pain Medicine
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A new preprint design is coming!
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Editorial decision: Accept
On 28 Sep, 2019
Editor assigned
On 27 Sep, 2019
Submission checks complete
On 26 Sep, 2019
Editor invited
On 26 Sep, 2019
No comments provided
Editorial decision: Minor revision
On 26 Sep, 2019
No comments provided
Editorial decision: Minor revision
On 19 Sep, 2019
Editor assigned
On 17 Sep, 2019
Submission checks complete
On 16 Sep, 2019
Editor invited
On 16 Sep, 2019
Version 2
Posted 18 Sep, 2019
No comments provided
Review #1 received
Received 06 Sep, 2019
Editorial decision: Minor revision
On 06 Sep, 2019
Reviewer #2 agreed
On 31 Aug, 2019
Editor assigned
On 30 Aug, 2019
Reviewers invited
Invitations sent on 30 Aug, 2019
Reviewer #1 agreed
On 30 Aug, 2019
Submission checks complete
On 29 Aug, 2019
Editor invited
On 29 Aug, 2019
No comments provided
Review #2 received
Received 28 Jul, 2019
Editorial decision: Major revision
On 28 Jul, 2019
Review #1 received
Received 21 Jul, 2019
Reviewer #1 agreed
On 17 Jul, 2019
Reviewer #2 agreed
On 17 Jul, 2019
Submission checks complete
On 17 Jul, 2019
Editor assigned
On 17 Jul, 2019
Reviewers invited
Invitations sent on 17 Jul, 2019
Editor invited
On 16 Jul, 2019
First submitted
On 08 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.
Figure 1
Figure 2
Figure 3
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