Fluid therapy in the PACU.
The goal of fluid therapy in the PACU setting is the restoration of blood volume and tissue perfusion. Choosing the type of fluid infusion depends on the preoperative, intraoperative, and postoperative condition of the patient. An understanding of the functional fluid compartments, the composition of body fluids and commercially available fluids, and the steps to evaluate fluid depletion allow one to determine the fluid needs of the patient. The orderly and expedient evaluation of fluid status of the postoperative patient involves the assessment of volume status, concentration status, composition status, and signs and symptoms of inadequate tissue perfusion. Recovery after surgery is a dynamic process, and fluid reassessment should be conducted periodically. Fluid challenges may be necessary in the hypovolemic patient or in patients with clear signs and symptoms of end-organ hypoperfusion. Weil and Rackow and Shoemaker provide useful approaches to fluid challenge guided by CVP and PAP monitoring. The decision of whether to use crystalloids or colloids for fluid resuscitation is complex, controversial, often determined by personal preference and concern over expense, and may be inconsequential as long as fluids are infused appropriate to the needs of the patient. There are disadvantages and advantages to both crystalloid and colloid fluid administration. As with any therapeutic intervention, there are complications with fluid administration, congestive heart failure and pulmonary edema being of more immediate concern. Finally, blood components are colloid-type solutions that should be reserved for specific patient problems. Red blood cells are indicated to increase oxygen-carrying capacity in patients with anemia. Platelets are used to treat bleeding associated with deficiencies in platelet number or function. Fresh frozen plasma is transfused to increase clotting factor levels in patients with demonstrated deficiency. A good understanding of fluid types available, of a systematic approach to evaluating fluid depletion, and of the indications for blood component therapy will allow one to make appropriate decisions when implementing fluid therapy in the PACU.
Jones
D H
DH
D001803:Blood Transfusion / Q000379:methods; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000379:methods / Q000451:nursing*; D006801:Humans; D007552:Isotonic Solutions; D010952:Plasma Substitutes / Q000627:therapeutic use; D011997:Recovery Room; D012151:Resuscitation; D014882:Water-Electrolyte Balance
D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes