Peri-operative use of synthetic intravenous fluid by peri-operative physicians in South Africa

Abstract

Background Peri-operative physicians increasingly acknowledge that fluid management influences patient outcome. Studies have attempted to understand the changes in practice following recently published evidence, although none have included significant contributions from South Africa. Methods An observational cohort study using an interactive online survey was conducted. Five underlying questions where highlighted during data analysis and these data were summarized into simplified categories for better comparison. Results Three hundred questionnaires where completed. During resuscitation of an unstable trauma patient, 233/300 (78%) use crystalloids, although 107/300 (36%) prefer blood products if available. Synthetic colloids for trauma patients unresponsive to initial fluid (normal haemoglobin) would be chosen first by 179/300 (60%), and 12/28 (46%) of non-anaesthesia physicians prefer blood products. Of interest, 10/300 (3%) would use either albumin or hypertonic saline when resuscitating a non-responding trauma patient. Concerning was 14/300 (5%) of respondents who would use fluid other than blood products for trauma patients with low haemoglobin. A relatively large proportion 47/300 (16%) would use synthetic colloids to resuscitate haemodynamically unstable septic patients. Conclusion The results presented are largely from anaesthesia practitioners and practice follows international trends. However, synthetic colloids are used in septic patients where evidence suggests otherwise. A lack of access to blood products probably influences practice. Findings suggest the need for continued attempts to translate research into clinical practice