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Postoperative Renal Failure in Trauma Patients

Since 1975 the authors had observed a sudden increase in the incidence of nonoliguric renal failure following anesthesia in trauma victims. In an attempt to find the possible causes they reviewed postoperative fluid management of 2,191 patients. During the period 1974–1975, fluid intake was increased and diuretics were administered in 960 postoperative trauma patients with oilguria (Group I). In those patients in Group I with respiratory insufficiency and oliguria, fluid therapy was restricted, and furosemide and albumin were administered. During the period of 1976–1977 postoperative creatinine and free-water clearance were monitored in 1,231 trauma victims (Group II). In patients with abnormal renal clearance values or ollguria, optimal cardiac output was maintained by maximizing preload. Diuretics were not administered unless circulatory overload was confirmed. There were 17 cases of acute renal failure in Group I and 18 in Group II. All of the 18 affected patients in Group II, but only three in Group I, were nonoliguric. Duration and severity of azotemia, complications, number of patients dialyzed, and mortality were significantly less (P < 0.05) in Group II than in Group I. It is concluded that when postoperative renal dysfunction is recognized early and therapy is directed toward attaining optimal blood volume, oliguria in acute renal failure may be avoided, thus minimizing morbidity and mortality.