title: A rational approach to perioperative fluid management.
abstract: Replacement of assumed preoperative deficits, in addition to generous substitution of an unsubstantiated increased insensible perspiration and third space loss, plays an important role in current perioperative fluid regimens. The consequence is a positive fluid balance and weight gain of up to 10 kg, which may be related to severe complications. Because the intravascular blood volume remains unchanged and insensible perspiration is negligible, the fluid must accumulate inside the body. This concept brings into question common liberal infusion regimens. Blood volume after fasting is normal, and a fluid-consuming third space has never been reliably shown. Crystalloids physiologically load the interstitial space, whereas colloidal volume loading deteriorates a vital part of the vascular barrier. The endothelial glycocalyx plays a key role and is destroyed not only by ischemia and surgery, but also by acute hypervolemia. Therefore, undifferentiated fluid handling may increase the shift toward the interstitial space. Using the right kind of fluid in appropriate amounts at the right time might improve patient outcome.
authors.affiliation: Clinic of Anesthesiology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chappell
authors.forename: Matthias
authors.initials: M
authors.lastname: Jacob
authors.forename: Klaus
authors.initials: K
authors.lastname: Hofmann-Kiefer
authors.forename: Peter
authors.initials: P
authors.lastname: Conzen
authors.forename: Markus
authors.initials: M
authors.lastname: Rehm
mesh_terms: D001810:Blood Volume; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D004730:Endothelium, Vascular / Q000378:metabolism; D005110:Extracellular Space / Q000378:metabolism; D005440:Fluid Therapy; D019276:Glycocalyx / Q000378:metabolism; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D019990:Perioperative Care; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions