EVALUATION OF PERIOPERATIVE FLUID MANAGEMENT STRATEGIES IN CARDIAC PATIENTS IN PAKISTAN

Abstract

Background: Perioperative fluid therapy plays a crucial role in maintaining hemodynamic stability in patients undergoing cardiac surgery. Proper fluid management ensures adequate organ perfusion, prevents hypovolemia, and reduces postoperative complications such as renal dysfunction and mortality. Both crystalloids and colloids are widely used for volume replacement; however, synthetic colloids have been associated with nephrotoxicity and coagulation disturbances, raising safety concerns. As a result, crystalloids are increasingly preferred in clinical practice. Despite international evidence comparing these fluids, limited local data are available in Pakistan to evaluate their safety and efficacy in cardiac surgery patients, highlighting the need for this study.

Objective: The primary objective of this study was to compare the outcomes of crystalloid versus colloid solutions for perioperative fluid management in cardiac surgery patients.

Methods: This was a descriptive, cross-sectional study conducted at Cardiac  Surgery  Department of Punjab Institute of Cardiology, Lahore from July 2025 to October 2025, including 400 patients (200 in each group) aged 30-70 years who were put under cardiac surgery under general anaesthesia. Patients were randomly divided into crystalloid (Ringer acetate 20 ml/kg) and colloid (Hydroxyethyl starch 10 ml/kg) groups. Mean arterial pressure (MAP), serum creatinine levels (preoperative condition, and 24 hours after surgery), and mortality were measured. The SPSS version 27 was used to analyse the data.

Results: Intraoperative MAP remained stable in both groups without significant difference. Postoperative serum creatinine levels were higher in the colloid group compared to the crystalloid group (p≤0.05). In-hospital mortality was low and comparable between both groups (p>0.05).

Conclusion: Crystalloid was found to be more hemodynamically stable and safer to the kidneys compared with colloid hence will be well warranted to use crystalloid than colloid during surgery in treating perioperative fluid therapy in patients undergoing cardiac surgeries.