Practical guidelines on fluid therapy pdf

Fluid therapy is often the first line of hemodynamic support because decreased effective circulating blood volume often accompanies induction of anesthesia and surgical trauma. Specific hemodynamic goals include maintaining adequate blood volume and sustaining perfusion pressure so as to maintain cardiac output, tissue blood flow, and adequate oxygen delivery. The physiologic principles of fluid supportДЄ patientвЂ™s physiologic status in general and hemodynamic stability in particular define the need for cardiovascular support, including fluid therapy and use of vasoactive drugs (vasopressors, vasodilators) and inotropes. It is the purpose of this review to provide an overview of the components of an effective perioperative fluid administration plan. More compelling are several meta-analyses and quantitative reviews demonstrating the strength of these beneficial effects across patient groups and surgical procedures. Multiple studies have shown that approaching fluid therapy with the goal of hemodynamic stabilization can reduce complications after major surgery.

Fluid therapy should be considered when patients are both in need of enhanced blood flow and are fluid responsive. Currently taught and practiced methods of intraoperative volume management in which intravenous fluids are given based on a generalizable formula relying on body weight per unit time and modified by the perceived magnitude of surgical вЂtraumaвЂ™ are not supported by known physiologic principles. Perioperative morbidity is linked to the amount of intravenous fluid administered (fluid therapy) with both insufficient and, more commonly, excess fluid delivery leading to increased postoperative complications. There is wide variability of practice, both between individuals and institutions. Perioperative fluid management remains a highly debated topic. The prevention of postoperative morbidity is a key factor in providing high-quality, high-value health care. The occurrence of one or more postoperative complications adversely effects both short-term and long-term survival and increases healthcare costs. Major surgery is a considerable physiologic insult that can be associated with significant morbidity and mortality. This paper provides a general approach to fluid therapy and practical recommendations. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. Patients should receive fluid therapy guided by predefined physiologic targets. We recommend that both perioperative fluid choice and therapy be individualized. The results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration. This manuscript is the result of 3В years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations.

From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. MethodsД«ased on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Perioperative fluid therapy remains a highly debated topic.

Practical guidelines on fluid therapy pdf