STRATEGIES FOR PERIOPERATIVE FLUID THERAPY: GOAL-DIRECTED VS LIBERAL AND RESTRICTIVE (literature review)

Abstract

The review highlights the analysis of modern literature data from randomized multicenter controlled trials conducted in the world in order to determine the optimal strategy for perioperative fluid therapy in both planned and urgent interventions. To date, despite a large number of studies on the effect of perioperative infusion therapy volumes on treatment outcome in abdominal operations, conflicting data have been obtained. There is no convincing evidence about the benefits of restrictive, liberal regimes or goal-directed fluid therapy, although from both theoretical and practical points of view, none of the researchers doubts the fact that maintaining an optimal balance requires an individual approach, which could reduce many postoperative complications. Recently, researchers have pointed out the advantages of goal-directed infusion therapy as one of the components of the ERAS protocol, the strategy which based on the regulation of cardiac output (SV) and stroke volume (UO) and achieving intraoperative zero fluid balance, especially in high-risk patients with concomitant diseases of cardio-vascular system. Recent multicenter studies such as RELIEF compared the restrictive and liberal regimes of fluid therapy and concluded that perioperative fluid management in extensive operations should be achieved using a “conditionally liberal regimen” with positive water balance of one to two liters by the end of the operation. Researchers are revising the concept of fluid loss in the “third space” and the need for its compensation. The role of endothelial glycocalyx in maintaining the integrity of the endothelium, as well as the reaction of atrial natriuretic peptide (ANP) to volumetric fluid overload, which provokes platelet aggregation, increases vascular permeability and, as a result, manifests tissue edema, is shown. Large-scale RELIEF and OPTIMISE studies are continuing in this direction in order to offer the optimal regimen of perioperative fluid therapy for various surgical interventions.