Perioperative fluid management: Consensus statement from the enhanced recovery partnership

Mythen, Monty; Swart, Michael; Acheson, Nigel; Crawford, Robin; Jones, Kerri; Kuper, Martin; McGrath, John; Horgan, Alan

doi:10.1186/2047-0525-1-2

Cited by 98 publications

(77 citation statements)

References 9 publications

(7 reference statements)

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“…20 Maintenance fluid requirements during surgery can be delivered with a 1-3 mLÁkg -1Áhr -1 infusion of a balanced crystalloid solution. 19,21 The aim should be to maintain preoperative body weight. The term, fluid restriction, should be abandoned as it implies causing deliberate hypovolemia; the published regimens using a ''restrictive'' fluid strategy aim to maintain preoperative body weight.…”

Section: Maintenance Fluid Therapymentioning

confidence: 99%

“…21 We recommend that all patients should have an individualized plan for fluid management that matches the monitoring needs with patient and surgical risk (Fig. 2).…”

Section: Goal-directed Fluid Therapy Within An Eras Protocolmentioning

confidence: 99%

“…If intravenous fluids are to be given, the clinician should always ask the question, ''What are we giving fluids for?'' 21 The average patient without ongoing fluid deficits or losses should be encouraged to drink at least 1.75 LÁday -1 to meet their daily fluid requirements. 55 Patients with a thoracic epidural who are hypotensive and normovolemic do not benefit from additional excess fluid.…”

Section: Postoperative Fluid Managementmentioning

confidence: 99%

See 2 more Smart Citations

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

137

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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Section: Maintenance Fluid Therapymentioning

confidence: 99%

“…21 We recommend that all patients should have an individualized plan for fluid management that matches the monitoring needs with patient and surgical risk (Fig. 2).…”

Section: Goal-directed Fluid Therapy Within An Eras Protocolmentioning

confidence: 99%

Section: Postoperative Fluid Managementmentioning

confidence: 99%

See 1 more Smart Citation

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

137

View full text Add to dashboard Cite

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“…Many patients who are undergoing major surgery outside of ERAS pathways (i.e., vascular surgery) will also benefit for GDFT. Guidelines have been published recommending the types of cases when GDFT should be considered [51]. Ultimately, the need for GDFT is patient, surgeon, procedure, and institution specific.…”

Section: Recent Studies Of Gdft Within An Enhanced Recovery Programmentioning

confidence: 99%

State-of-the-art fluid management in the operating room

Miller

Raghunathan

Gan

2014

Best Practice & Research Clinical Anaesthesiology

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The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.

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“…Several considerations must be taken into account when administering intravenous fluids in the context of an ERAS program. 81 The minimization of preoperative fasting, select use of MBP, a more rational and evidence-based intravenous fluid administration, and early resumption of oral intake have significantly reduced the amount of perioperative intravenous fluids ( Table 3).…”

Section: Prevention Of Hypothermiamentioning

confidence: 99%