Comparación de los días libres de ventilación mecánica invasiva con la estrategia de fluidoterapia restrictiva vs convencional en pacientes postoperados de neurocirugía: cohorte retrospectivo

Abstract: Optimal fluid management in neurosurgical patients is crucial to maintain adequate cerebral perfusion and limit complications such as cerebral edema; however, the available evidence regarding the effects of restrictive and conventional strategies on respiratory outcomes remains contradictory. Objective: To determine the difference in the mean number of invasive mechanical ventilator-free days in postoperative neurosurgical patients managed with a restrictive versus a conventional fluid therapy strategy. Material and methods: Retrospective cohort study including 117 adult patients who underwent brain tumor resection in a high-specialty center. Patients were classified into two groups according to the administered fluid therapy strategy (restrictive vs conventional), and the number of invasive mechanical ventilator-free days during the first days of the postoperative period was compared. Descriptive and comparative analyses were performed, as well as Cox regression models to explore the association between clinical variables and ventilator-free days. Results: No statistically significant differences were observed in ventilator-free days between the restrictive strategy (4.04 days [3.37]) and the conventional strategy (4.22 days [2.79]); p = 0.76. Intraoperative blood loss (HR: 1.00; 95% CI: 1.00– 1.00; p = 0.02) and FiO2 (HR: 1.05; 95% CI: 1.00–1.10; p = 0.01) were associated with a lower number of ventilator-free days. Conclusions: In this cohort of neurosurgical patients, a restrictive or conventional fluid therapy strategy did not modify the number of invasive mechanical ventilator-free days. Factors such as intraoperative blood loss and ventilatory parameters like FiO2 appear to have a greater impact on the duration of ventilatory support and should be considered when optimizing perioperative management.