Substantial variation of both opinions and practice regarding perioperative fluid resuscitation.
BACKGROUND
There are no current standards of care guiding perioperative fluid administration, and clinicians continue to debate restrictive versus liberal fluid administration. We sought to simultaneously evaluate the opinions and practice of surgeons, intensivists and anesthesiologists in a single centre regarding perioperative fluid resuscitation.


METHODS
A postal survey sent to surgeons, intensivists and anesthesiologists in a single academic health care centre presented case-based scenarios followed by questions on fluid requirements and 5-point Likert scales involving statements about resuscitation. We performed a retrospective chart review to evaluate amount and type of intra-and postoperative (72-h) fluid administration, urine output and postoperative ventilation time in patients undergoing uncomplicated esophagectomy or pneumonectomy.


RESULTS
Seventy-four of 77 respondents (96%) agreed that precise fluid resuscitation diminishes the risk of adverse events. Surgeons overall gave less fluids than anesthesiologists or intensivists and used fewer resuscitation end points to estimate fluid requirements perioperatively. For right hemicolectomies, only 3% of surgeons chose a fluid rate greater than 150 mL/h, compared with 55% of intensivists. We reviewed 49 patients' charts (25 who had pneumonectomies, 24 who had esophagectomies) retrospectively. The coefficient of variation (COV = standard deviation divided by its mean) of fluid administration intraoperatively was 0.56 for pneumonectomy and 0.35 for esophagectomy; postoperatively, the COV was greater than 0.50 for the first 24 hours, but less than 0.50 after 24 hours postoperatively.


CONCLUSIONS
The presence of substantial variability of both opinion and practice of perioperative fluid resuscitation in a single centre supports the need for further research to identify objective methods to define perioperative fluid requirements and standards of perioperative resuscitation.
Chong
Peter C
PC
Department of Surgery, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont.
Greco
Elisa F
EF
Stothart
Danielle
D
Maziak
Donna E
DE
Sundaresan
Sudhir
S
Shamji
Farid M
FM
Neilipovitz
David
D
McIntyre
Lauralyn
L
Hébert
Paul
P
Seely
Andrew J E
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D016629:Esophagectomy; D005260:Female; D005440:Fluid Therapy; D019538:Health Care Surveys; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011182:Postoperative Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult