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Perioperative fluid therapy: a statement from the international Fluid Optimization Group.

Navarro LH, Bloomstone JA, Auler JO, Cannesson M, Rocca GD, Gan TJ, Kinsky M, Magder S, Miller TE, Mythen M, Perel A, Reuter DA, Pinsky MR, Kramer GC - Perioper Med (Lond) (2015)

Bottom Line: Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period.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.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.

View Article: PubMed Central - PubMed

Affiliation: Anesthesiology Department, Botucatu Medical School University of Sao Paulo State - UNESP, District of Rubiao Junior s/n, Botucatu, Sao Paulo, 18618-970 Brazil.

ABSTRACT

Background: Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. 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. 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. There is wide variability of practice, both between individuals and institutions. 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.

Methods: Based 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. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 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.

Results: 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.

Conclusions: We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations.

No MeSH data available.


Related in: MedlinePlus

Goal-directed hemodynamic algorithm to guide intraoperative volume therapy in major abdominal surgeries: (a) initial assessment and treatment and (b) further intraoperative optimization [58] (used per BioMed Central’s creative commons license). PPV, pulse pressure variation; CI, cardiac index; MAP, mean arterial pressure.
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Fig2: Goal-directed hemodynamic algorithm to guide intraoperative volume therapy in major abdominal surgeries: (a) initial assessment and treatment and (b) further intraoperative optimization [58] (used per BioMed Central’s creative commons license). PPV, pulse pressure variation; CI, cardiac index; MAP, mean arterial pressure.

Mentions: Importantly, algorithms should not be fixed, they should allow for individualizing fluid therapy based on changing physiologic need and response to fluid and drug therapy. Algorithms can become very detailed and are likely to be best implemented with computerized decision support [125,126]. Both guidelines and algorithms can be displayed in flow chart format or computerized. Figure 2 provides an example of fluid therapy algorithm [58]. There will be many perioperative events that require deviation from algorithms. There is no substitute for medical training and expertise; however, deviation from any protocol should have a rational basis. Furthermore, nonadherence is often an opportunity to better understand and improve guidelines and algorithms.Figure 2


Perioperative fluid therapy: a statement from the international Fluid Optimization Group.

Navarro LH, Bloomstone JA, Auler JO, Cannesson M, Rocca GD, Gan TJ, Kinsky M, Magder S, Miller TE, Mythen M, Perel A, Reuter DA, Pinsky MR, Kramer GC - Perioper Med (Lond) (2015)

Goal-directed hemodynamic algorithm to guide intraoperative volume therapy in major abdominal surgeries: (a) initial assessment and treatment and (b) further intraoperative optimization [58] (used per BioMed Central’s creative commons license). PPV, pulse pressure variation; CI, cardiac index; MAP, mean arterial pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403901&req=5

Fig2: Goal-directed hemodynamic algorithm to guide intraoperative volume therapy in major abdominal surgeries: (a) initial assessment and treatment and (b) further intraoperative optimization [58] (used per BioMed Central’s creative commons license). PPV, pulse pressure variation; CI, cardiac index; MAP, mean arterial pressure.
Mentions: Importantly, algorithms should not be fixed, they should allow for individualizing fluid therapy based on changing physiologic need and response to fluid and drug therapy. Algorithms can become very detailed and are likely to be best implemented with computerized decision support [125,126]. Both guidelines and algorithms can be displayed in flow chart format or computerized. Figure 2 provides an example of fluid therapy algorithm [58]. There will be many perioperative events that require deviation from algorithms. There is no substitute for medical training and expertise; however, deviation from any protocol should have a rational basis. Furthermore, nonadherence is often an opportunity to better understand and improve guidelines and algorithms.Figure 2

Bottom Line: Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period.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.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.

View Article: PubMed Central - PubMed

Affiliation: Anesthesiology Department, Botucatu Medical School University of Sao Paulo State - UNESP, District of Rubiao Junior s/n, Botucatu, Sao Paulo, 18618-970 Brazil.

ABSTRACT

Background: Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. 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. 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. There is wide variability of practice, both between individuals and institutions. 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.

Methods: Based 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. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 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.

Results: 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.

Conclusions: We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations.

No MeSH data available.


Related in: MedlinePlus