- 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]
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.