perioperative fluid management

Management

• fluid restriction if any cardiopulmonary compromise, especially heart failure

Clinical trials

Trial

One of the few (if only) randomized trial

141 patients, median age 66 years

patients undergoing elective colorectal resection

median IV fluid volume on day of surgery:

• standard group: 5388 mL
• fluid restriction: 2740 mL

post operative day 1

• standard group: 1500 mL
• fluid restriction: 500 mL

complications less common in fluid-restricted group (33% vs 51%)

difference due to lower cardiopulmonary & wound-healing complications in the restricted group.

four patients in the standard group & none in the restricted group died from pulmonary complications:

• pulmonary edema (2)
• pneumonia (1)
• pulmonary embolism (1)

Trial

• balanced crystalloid (10 mL/kg body weight) during induction of anesthesia, & fluid rates of 8 mL/kg/hour until the end of surgery & 1.5 mL/kg/hour for 1 day postoperatively
• restrictive-fluid group received fluids at roughly half those rates
• 24 hours after surgery, median fluid received was 6.1 L in the liberal group & 3.6 L in the restrictive group

• disability-free survival at 1 year = 82% in both groups
• acute kidney injury was less common in the liberal group (5.0% vs 8.6%)
• surgical site infections less common in the liberal group (13.6% vs 16.5%)

More general terms

• perioperative management