Tags

Type your tag names separated by a space and hit enter

Fluid therapy in the perioperative setting-a clinical review.
J Intensive Care. 2016; 4:27.JI

Abstract

BACKGROUND

Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice.

RESULTS

Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance. Hence, the intake of fluid (preferably containing carbohydrates) should be encouraged up to 2 h prior to surgery in order to avoid dehydration. Excessive intravenous fluid administration adds to tissue inflammation and edema formation, thereby compromising tissue healing. During major abdominal surgery a "zero-balance" intraoperative fluid strategy aims at avoiding fluid overload (and comparable to the so-called restrictive approach) as well as goal-directed fluid therapy (GDT). Both proved to significantly reduce postoperative complications when compared to "standard fluid therapy". Trials comparing "restrictive" or zero-balance and GDT have shown equal results, as long as fluid overload is avoided in the GDT group as well (categorized as "zero-balance GDT"). It is possible that high-risk surgical patients, such as those undergoing acute surgery, may benefit from the continuous monitoring of circulatory status that the GDT provides. Data on this group of patients is not available at present, but trials are ongoing.

CONCLUSION

In elective surgery, the zero-balance approach has shown to reduce postoperative complications and is easily applied for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being.

Authors+Show Affiliations

Department of Surgery, Holbaek University Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.Department of Surgery, Holbaek University Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27087980

Citation

Voldby, Anders Winther, and Birgitte Brandstrup. "Fluid Therapy in the Perioperative Setting-a Clinical Review." Journal of Intensive Care, vol. 4, 2016, p. 27.
Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting-a clinical review. J Intensive Care. 2016;4:27.
Voldby, A. W., & Brandstrup, B. (2016). Fluid therapy in the perioperative setting-a clinical review. Journal of Intensive Care, 4, 27. https://doi.org/10.1186/s40560-016-0154-3
Voldby AW, Brandstrup B. Fluid Therapy in the Perioperative Setting-a Clinical Review. J Intensive Care. 2016;4:27. PubMed PMID: 27087980.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluid therapy in the perioperative setting-a clinical review. AU - Voldby,Anders Winther, AU - Brandstrup,Birgitte, Y1 - 2016/04/16/ PY - 2016/02/04/received PY - 2016/04/07/accepted PY - 2016/4/19/entrez PY - 2016/4/19/pubmed PY - 2016/4/19/medline KW - Fluid therapy KW - Goal-directed fluid therapy KW - Outcome of surgery KW - Postoperative complications KW - Restricted KW - Third space KW - Third space loss SP - 27 EP - 27 JF - Journal of intensive care JO - J Intensive Care VL - 4 N2 - BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance. Hence, the intake of fluid (preferably containing carbohydrates) should be encouraged up to 2 h prior to surgery in order to avoid dehydration. Excessive intravenous fluid administration adds to tissue inflammation and edema formation, thereby compromising tissue healing. During major abdominal surgery a "zero-balance" intraoperative fluid strategy aims at avoiding fluid overload (and comparable to the so-called restrictive approach) as well as goal-directed fluid therapy (GDT). Both proved to significantly reduce postoperative complications when compared to "standard fluid therapy". Trials comparing "restrictive" or zero-balance and GDT have shown equal results, as long as fluid overload is avoided in the GDT group as well (categorized as "zero-balance GDT"). It is possible that high-risk surgical patients, such as those undergoing acute surgery, may benefit from the continuous monitoring of circulatory status that the GDT provides. Data on this group of patients is not available at present, but trials are ongoing. CONCLUSION: In elective surgery, the zero-balance approach has shown to reduce postoperative complications and is easily applied for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being. SN - 2052-0492 UR - https://www.unboundmedicine.com/medline/citation/27087980/Fluid_therapy_in_the_perioperative_setting_a_clinical_review_ L2 - https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-016-0154-3 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.