Perioperative fluid management
OVERVIEW
- an adequate and timely replacement of actual losses with appropriate preparations seems to be an ideal primary approach
- we should divide fluid therapy into two components:
- replacement of fluid losses from the body via insensible perspiration (~500mL/24h), bowel motions (~200mL/24h) and urinary output (500-2000 mL/24h) and
- replacement of plasma losses from the circulation due to fluid shifting or acute bleeding
- While a goal-directed approach via circulatory surrogates is, in principle, possible to replace plasma losses, the extracellular compartment cannot currently be monitored
RULES OF THUMB
- the extracellular deficit after usual fast is low
- use crystalloid only for insensible losses and urine output
- Insensible losses =0.5 ml/kg/hr or 1 ml/kg/hr if the abdomen is open
- primarily fluid-consuming third space does not exist
- replace circulatory plasma loss with iso-oncotic colloid (e.g. 4% albumin)
References and Links
- Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008 Oct;109(4):723-40. PMID: 18813052.
- Hilton AK, Pellegrino VA, Scheinkestel CD. Avoiding common problems associated with intravenous fluid therapy. Med J Aust. 2008 Nov 3;189(9):509-13. PMID: 18976194.
- Mac Sweeney R, et al. Perioperative Intravenous Fluid Therapy for Adults Ulster Med J 2013;82(3):171-178 [Free Full Text]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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