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Perioperative fluid management: From physiology to improving clinical outcomes.

Bennett, VA; Cecconi, M (2017) Perioperative fluid management: From physiology to improving clinical outcomes. Indian J Anaesth, 61 (8). pp. 614-621. ISSN 0019-5049 https://doi.org/10.4103/ija.IJA_456_17
SGUL Authors: Bennett, Victoria Anne

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Abstract

Perioperative fluid management is a key component in the care of the surgical patient. It is an area that has seen significant changes and developments, however there remains a wide disparity in practice between clinicians. Historically, patients received large volumes of intravenous fluids perioperatively. The concept of goal directed therapy was then introduced, with the early studies showing significant improvements in morbidity and mortality. The current focus is on fluid therapy guided by an individual patient's physiology. A fluid challenge is commonly performed as part of an assessment of a patient's fluid responsiveness. There remains wide variation in how clinicians perform a fluid challenge and this review explores the evidence for how to administer an effective challenge that is both reliable and reproducible. The methods for monitoring cardiac output have evolved from the pulmonary artery catheter to a range of less invasive techniques. The different options that are available for perioperative use are considered. Fluid status can also be assessed by examining the microcirculation and the importance of recognising the possibility of a lack of coherence between the macro and microcirculation is discussed. Fluid therapy needs to be targeted to specific end points and individualised. Not all patients who respond to a fluid challenge will necessarily require additional fluid administration and care should be aimed at identifying those who do. This review aims to explain the underlying physiology and describe the evidence base and the changes that have been seen in the approach to perioperative fluid therapy.

Item Type: Article
Additional Information: This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Keywords: Cardiac output, fluid, perioperative, physiology, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Journal or Publication Title: Indian J Anaesth
ISSN: 0019-5049
Language: eng
Dates:
DateEvent
11 August 2017Published
Publisher License: Creative Commons: Attribution-Noncommercial-Share Alike 3.0
PubMed ID: 28890555
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/109155
Publisher's version: https://doi.org/10.4103/ija.IJA_456_17

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