Intraoperative fluid losses revisited

Abstract

SUMMARY Intravenous fluid therapy is an essential element of surgical procedures. However, consensus regarding the optimal volume and composition of fluid is still lacking. Despite increasing evidence that aggressive crystalloid‐based resuscitation is associated with several complications large volumes are still used peroperatively. The aim of this paper is to investigate the pathophysiology behind fluid losses and how to best administer peroperative fluids in appropriate amounts.

Editorial: recent advances in perioperative volume replacement therapy through a more physiological approach of the high-risk surgical patient

“…Improved assessment of the ‘non‐surgical’ fluid losses that occur during major interventions: some of the concepts concerning fluid evaporation and the creation of a ‘third space’ during major surgery have been questioned, leading to a marked decrease in the volume of crystalloid to be administered in this context 6 …”

“…• Improved assessment of the 'non-surgical' fluid losses that occur during major interventions: some of the concepts concerning fluid evaporation and the creation of a 'third space' during major surgery have been questioned, leading to a marked decrease in the volume of crystalloid to be administered in this context. 6 • A more precise knowledge of the barrier separating the intravascular and interstitial spaces: the healthy vascular endothelium is luminally coated by a structure consisting of membrane-bound proteoglycans and glycoproteins building up a network, the endothelial glycocalyx, which has a major impact on transvascular fluid shifts. 7 • The development of more accurate monitoring tools for assessing fluid responsiveness in the operating room and in the intensive care unit.…”