Towards a new standard of perioperative fluid management

Conor J Shields

Department of Surgery, Mater Misericordiae Hospital, Eccles St, Dublin 7, Ireland

Abstract: Recent studies suggest that current fluid strategies may result in excessive administration of both fluids and electrolytes. Perioperative fluid administration is dictated by an algorithmic approach, taking account of pre-operative deficit, maintenance requirements, and extrapolated third space losses. Salt and water overload is associated with pulmonary edema, ileus, and delayed wound healing. Within an intensive care population, there is a strong correlation between excessive intravascular volume and subsequent mortality, morbidity, and length of stay. Increasing weight has been shown to correspond with mortality, while achieving a negative balance within the first 72 hours of ITU admission has been postulated as an independent predictor of survival. Should a “restricted” rather than a “liberal” perioperative fluid regimen be employed? It is arguable that prevailing fluid therapy is not evidence-based. Recent observations suggest that restraint in fluid administration correlates with better outcome. The development of a protocol-based fluid optimization program may help minimize the risk of perioperative fluid overload.

Keywords: perioperative fluid management, restriction, surgical outcome