Hemorrhage and operation cause a contraction of the extracellular space needing replacement—evidence and implications? A systematic review

Hemorrhagic Shock and Resuscitation-Mediated Tissue Water Distribution is Normalized by Adjunctive Peritoneal Resuscitation

“…This is in large part because of the difficulty getting accurate experimental assessments of fluid shifts during hemorrhagic shock and resuscitation. 10 During hemorrhagic shock resuscitation, fluid shifts occur at the cell-interstitium interface and at the vascular, primarily capillary-interstitium interface. The shift of fluid at the cellinterstitium interface is an adaptive cell volume regulatory mechanism, and capillaryinterstitium fluid shifts are precipitated by perturbation of the transcapillary Starling forces.…”

Multimodal monitoring (MMM) in the perioperative period

“…Interestingly, recent papers and reviews have confirmed that "there is no convincing evidence supporting the existence of the non-anatomical third space loss neither in haemorrhagic shock nor in surgery of any kind". (11)(12)(13)(14) This highlights another problem. Third space loss does exist in conditions such as septic shock, anaphylaxis and burn injury and it is important to distinguish fluid and flow requirements in elective surgery in contradistinction to haemodynamic changes in the intensive care unit where sepsis may well be a serious problem.…”

Monitoring Needs and Goal-directed Fluid Therapy Within an Enhanced Recovery Program

“…5 Although deeply entrenched in clinical teaching and practice for decades, there is minimal evidence that third-space loss occurs. 6 There is a paucity of large-scale perioperative studies to date, but many small trials, systematic reviews, and meta-analyses consistently favor a restrictive approach. 5,[7][8][9] It is relevant that a recent randomized controlled trial (RCT) of resuscitation strategies for gastroenteritis in sub-Saharan African children linked liberal fluid prescription with an increased mortality.…”