Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance

Clinical Assessment of Fluid Balance is Incomplete for Colorectal Surgical Patients

“…Several studies, however, clearly show that fluid overload leads to poor patient outcome as well. Excessive amounts of intraoperative fluid causes decreased pulmonary function (17), reduced gut motility (3,18), and postoperative complications and increased morbidity in both vascular surgery (19,20), pneumonectomy (21,22), and liver transplantation (23). Furthermore, intraoperative fluid "restriction" predicts shorter length of stay in ICU after, respectively, spine (24) or vascular (25) surgery and in the gastrointestinal surgery restriction or "zero-balance" fluid therapy reduces postoperative complications (2,3,26,27).…”

Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction,

“…18 Intraoperative fluid restriction is unique to our patient management; this is one of the first series to report its potential benefits. 19,20 Limiting intraoperative fluids should reduce third space fluid shift into pulmonary and gastrointestinal tissues manipulated during esophagectomy. An algorithm that uses a mL/kg/h formula based on preoperative deficits, maintenance requirements, third space loss, and blood loss typically guides intraoperative crystalloid administration.…”

Postoperative Care of Patients Undergoing Lung Resection

“…Studies have shown that early onset ALI can be partially prevented by careful perioperative fluid management. According to Moller et al [31], administration of less than 3 liters of fluids in the first 24 hours or lower positive fluid balance over the first 3 days have been associated with reduced incidence of ALI. Perioperative generous fluid replacement is particularly deleterious once extubation and spontaneous ventilation have been regained because the increase in venous return at withdrawal of mechanical ventilation may determine interstitial congestion in the residual lung parenchyma [32].…”