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

Abstract

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.

Addressing the Global Burden of Trauma in Major Surgery

“…Importantly, IV infusion rates were kept low (1.0 ml/kg/h) to avoid “secondary hit” complications from fluid overload such as cardiovascular and endothelial dysfunction, inflammation and coagulopathy. These low volumes are consistent with human studies by Lamke and colleagues who showed that the basal evaporation rate and typical fluid losses in humans undergoing major abdominal surgery were ~0.5 ml/kg/h ( 313 , 314 ). Today, high fluid volumes up to 3–4 l are common in major surgery and may amplify the stress response by shocking the body a second time ( 315 – 317 ).…”

Excessive intravenous fluid therapy in head and neck cancer surgery

“…Perioperative and postoperative care of patients undergoing surgery includes intravenous fluid administration and — in case of anemia or major bleeding red blood cell (RBC) transfusion — care in the intensive care unit (ICU) and many other measures to insure the best possible outcome. The goal of perioperative fluid administration is often maintenance of euvolemia and adequate perfusion pressure to the heart and kidneys. The influence of perioperative fluid administration and RBC transfusion on cardiac and cerebrovascular complications, however, is not well‐documented in this patient group.…”

Assessment of hypovolaemia in the critically ill

“…When someone loses blood, an initial physiological response is to recruit fluid from the distal compartments to the central compartment. The splanchnic mesenteric reserves are the first to provide by means of vasoconstriction [5]. The activation of the reninangiotensin-aldosterone-system (RAAS) results in water and sodium retention which replenishes the interstitial reserves and maintains the transcapillary perfusion [6].…”