N Heming1,2, P Moine1,2, R Coscas3,4, D Annane1,2. 1. General Intensive Care Unit, Raymond Poincaré Hospital, GHU APHP University Paris-Saclay, Garches, France. 2. U1173 Laboratory of Inflammation and Infection, University of Versailles Saint-Quentin-en-Yvelines (UVSQ) and University Paris-Saclay - Institut National de la Santé et de la Recherche Médicale (INSERM), Montigny-le-Bretonneux, France. 3. Department of Vascular Surgery, Ambroise Paré Hospital, GHU APHP University Paris-Saclay, Boulogne-Billancourt, France. 4. U1018, Centre de Recherche en Épidémiologie et Santé des Populations, UVSQ and University Paris-Saclay, Villejuif, France.
Abstract
BACKGROUND: Adequate fluid balance before, during and after surgery may reduce morbidity. This review examines current concepts surrounding fluid management in major elective surgery. METHOD: A narrative review was undertaken following a PubMed search for English language reports published before July 2019 using the terms 'surgery', 'fluids', 'fluid therapy', 'colloids', 'crystalloids', 'albumin', 'starch', 'saline', 'gelatin' and 'goal directed therapy'. Additional reports were identified by examining the reference lists of selected articles. RESULTS: Fluid therapy is a cornerstone of the haemodynamic management of patients undergoing major elective surgery. Both fluid overload and hypovolaemia are deleterious during the perioperative phase. Zero-balance fluid therapy should be aimed for. In high-risk patients, individualized haemodynamic management should be titrated through the use of goal-directed therapy. The optimal type of fluid to be administered during major surgery remains to be determined. CONCLUSION: Perioperative fluid management is a key challenge during major surgery. Individualized volume optimization by means of goal-directed therapy is warranted during high-risk surgery. In most patients, balanced crystalloids are the first choice of fluids to be used in the operating theatre. Additional research on the optimal type of fluid for use during major surgery is needed.
BACKGROUND: Adequate fluid balance before, during and after surgery may reduce morbidity. This review examines current concepts surrounding fluid management in major elective surgery. METHOD: A narrative review was undertaken following a PubMed search for English language reports published before July 2019 using the terms 'surgery', 'fluids', 'fluid therapy', 'colloids', 'crystalloids', 'albumin', 'starch', 'saline', 'gelatin' and 'goal directed therapy'. Additional reports were identified by examining the reference lists of selected articles. RESULTS: Fluid therapy is a cornerstone of the haemodynamic management of patients undergoing major elective surgery. Both fluid overload and hypovolaemia are deleterious during the perioperative phase. Zero-balance fluid therapy should be aimed for. In high-risk patients, individualized haemodynamic management should be titrated through the use of goal-directed therapy. The optimal type of fluid to be administered during major surgery remains to be determined. CONCLUSION: Perioperative fluid management is a key challenge during major surgery. Individualized volume optimization by means of goal-directed therapy is warranted during high-risk surgery. In most patients, balanced crystalloids are the first choice of fluids to be used in the operating theatre. Additional research on the optimal type of fluid for use during major surgery is needed.
Authors: Juan Victor Lorente; Ignacio Jimenez; Javier Ripollés-Melchor; Alejandra Becerra; Wilbert Wesselink; Francesca Reguant; Irene Mojarro; Maria de Los Angeles Fuentes; Ane Abad-Motos; Elizabeth Agudelo; Francisco Herrero-Machancoses; Paula Callejo; Joan Bosch; Manuel Ignacio Monge Journal: BMJ Open Date: 2022-06-02 Impact factor: 3.006
Authors: Antonio Messina; Chiara Robba; Lorenzo Calabrò; Daniel Zambelli; Francesca Iannuzzi; Edoardo Molinari; Silvia Scarano; Denise Battaglini; Marta Baggiani; Giacomo De Mattei; Laura Saderi; Giovanni Sotgiu; Paolo Pelosi; Maurizio Cecconi Journal: Crit Care Date: 2021-02-01 Impact factor: 9.097
Authors: Juan V Lorente; Francesca Reguant; Anna Arnau; Marcelo Borderas; Juan C Prieto; Jordi Torrallardona; Laura Carrasco; Patricia Solano; Isabel Pérez; Carla Farré; Ignacio Jiménez; Javier Ripollés-Melchor; Manuel I Monge; Joan Bosch Journal: Perioper Med (Lond) Date: 2022-08-10
Authors: Antonio Messina; Chiara Robba; Lorenzo Calabrò; Daniel Zambelli; Francesca Iannuzzi; Edoardo Molinari; Silvia Scarano; Denise Battaglini; Marta Baggiani; Giacomo De Mattei; Laura Saderi; Giovanni Sotgiu; Paolo Pelosi; Maurizio Cecconi Journal: Crit Care Date: 2021-06-11 Impact factor: 9.097
Authors: Frank Daniel Martos-Benítez; Caridad de Dios Soler-Morejón; Karla Ximena Lara-Ponce; Versis Orama-Requejo; Dailé Burgos-Aragüez; Hilev Larrondo-Muguercia; Rahim W Lespoir Journal: World J Clin Oncol Date: 2020-10-24