[Determinants of insensible fluid loss. Perspiration, protein shift and endothelial glycocalyx].
Accurate perioperative fluid balance is the basis of a targeted infusion regimen. However, neither the initial status nor perioperative changes of the fluid compartments can be reliably measured in daily routine. In particular, insensible losses are not consistently assessed, so that substitution therapy is generally empirical. The object of this paper is to communicate the scientific data on this topic. Preoperative fasting (10 h) does not per se cause intravascular hypovolemia. In adults, total basal evaporation by way of the skin and airways and of any wounds during major abdominal interventions is usually less than 1 ml/kg/h. An inconstant fluid and protein shift towards the interstitial space perioperatively seems to be associated with hypervolemia, which suggests it should be preventable. The decisive factor in this context seems to be deterioration of the endothelial glycocalyx, whose further patho-physiological impact is currently only partially known. Clinical studies have revealed a link between fluid restriction and improved outcome after major abdominal surgery.
Jacob
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M
Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München Grosshadern-Innenstadt, Nussbaumstrasse 20, 80336 München. matthias.jacob@med.uni-muenchen.de
Chappell
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D
Hofmann-Kiefer
K
K
Conzen
P
P
Peter
K
K
Rehm
M
M
D000758:Anesthesia; D001802:Blood Substitutes / Q000008:administration & dosage / Q000627:therapeutic use; D004702:Endocrine Glands / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000166:cytology / Q000502:physiology*; D005440:Fluid Therapy; D019276:Glycocalyx / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control / Q000628:therapy; D020896:Hypovolemia / Q000517:prevention & control / Q000628:therapy; D007431:Intraoperative Complications / Q000503:physiopathology; D007552:Isotonic Solutions / Q000627:therapeutic use; D011506:Proteins / Q000502:physiology*; D013312:Stress, Physiological / Q000378:metabolism; D013546:Sweating / Q000502:physiology*; D014870:Water Loss, Insensible / Q000502:physiology*; D014947:Wounds and Injuries / Q000503:physiopathology
D001802:Blood Substitutes; D007552:Isotonic Solutions; D011506:Proteins