title: Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?
abstract: BACKGROUND
  Fluid management in the perioperative period has been extensively studied but, despite that, "the right amount" still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today.
  
  
  CONCLUSIONS
  In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence.
  
  
  CONCLUSIONS
  An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution.
authors.affiliation: Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Della Rocca
authors.affiliation: Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vetrugno
authors.affiliation: Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Tripi
authors.affiliation: Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Deana
authors.affiliation: Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Barbariol
authors.affiliation: Dipartimento di Scienze Mediche Sperimentali e Cliniche, University of Udine, University of Udine, 33100 Udine, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Pompei
mesh_terms: D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000592:standards*; D019990:Perioperative Care
keywords: Colloid versus crystalloid; Fluid management; Intraoperative fluid; Liberal versus restricted
references.citation: Crit Care. 2010;14(5):325
references.pmid: 21067552
references.citation: Chest. 1988 Dec;94(6):1176-86
references.pmid: 3191758
references.citation: Br J Anaesth. 2005 Nov;95(5):634-42
references.pmid: 16155038
references.citation: Arch Surg. 1995 Apr;130(4):423-9
references.pmid: 7535996
references.citation: N Engl J Med. 2012 Nov 15;367(20):1901-11
references.pmid: 23075127
references.citation: Microvasc Res. 2011 Nov;82(3):339-45
references.pmid: 21906604
references.citation: J Appl Physiol (1985). 1993 May;74(5):2566-73
references.pmid: 8335593
references.citation: Anaesthesia. 2009 Mar;64(3):235-8
references.pmid: 19302633
references.citation: Br J Anaesth. 2013 Feb;110(2):207-13
references.pmid: 23103777
references.citation: Anesthesiology. 2009 Jul;111(1):187-202
references.pmid: 19512862
references.citation: Am J Physiol Heart Circ Physiol. 2005 Nov;289(5):H1993-9
references.pmid: 15964925
references.citation: Crit Care. 2011;15(3):R132
references.pmid: 21624138
references.citation: Anesth Analg. 2013 Jan;116(1):35-48
references.pmid: 23115254
references.citation: Clin Pharmacokinet. 2005;44(7):681-99
references.pmid: 15966753
references.citation: JAMA. 2014 Jun 4;311(21):2181-90
references.pmid: 24842135
references.citation: Anesthesiology. 2005 Jul;103(1):25-32
references.pmid: 15983453
references.citation: Ann Surg. 2009 Jul;250(1):28-34
references.pmid: 19561485
references.citation: JAMA. 2001 Jul 18;286(3):309-14
references.pmid: 11466096
references.citation: World J Surg. 2013 Feb;37(2):259-84
references.pmid: 23052794
references.citation: BMJ. 1997 Oct 11;315(7113):909-12
references.pmid: 9361539
references.citation: Anesthesiology. 2008 Oct;109(4):723-40
references.pmid: 18813052
references.citation: Crit Care. 2005;9(6):R687-93
references.pmid: 16356219
references.citation: Br J Surg. 2012 Feb;99(2):186-91
references.pmid: 21948211
references.citation: Anesth Analg. 2007 Aug;105(2):465-74
references.pmid: 17646507
references.citation: Curr Opin Crit Care. 2002 Jun;8(3):257-61
references.pmid: 12386506
references.citation: Crit Care. 2011 Jun 24;15(3):R154
references.pmid: 21702945
references.citation: BMC Anesthesiol. 2013 Feb 22;13:5
references.pmid: 23433064
references.citation: Shock. 2008 May;29(5):572-6
references.pmid: 18414231
references.citation: Br J Anaesth. 2008 Aug;101(2):141-50
references.pmid: 18534973
references.citation: J Surg Res. 2011 Jan;165(1):136-41
references.pmid: 19560161
references.citation: Crit Care. 2013 Sep 08;17(5):R191
references.pmid: 24010849
references.citation: Acta Chir Scand. 1977;143(5):279-84
references.pmid: 596094
references.citation: Br J Anaesth. 2007 Oct;99(4):500-8
references.pmid: 17681972
references.citation: Crit Care. 2013 Jul 26;17(4):R166
references.pmid: 23890518
references.citation: Crit Care Resusc. 2000 Jun;2(2):150-5
references.pmid: 16597302
references.citation: Ann Surg. 2003 Nov;238(5):641-8
references.pmid: 14578723
references.citation: Anesth Analg. 2011 Jun;112(6):1392-402
references.pmid: 20966436
references.citation: Anaesthesia. 2013 Jul;68(7):684-8
references.pmid: 23672246
references.citation: Dan Med Bull. 2010 Jul;57(7):B4156
references.pmid: 20591343
references.citation: Crit Care. 2011;15(5):R226
references.pmid: 21943111
references.citation: Br J Surg. 2006 Sep;93(9):1069-76
references.pmid: 16888706
references.citation: Crit Care. 2011 Aug 18;15(4):229
references.pmid: 21884645
references.citation: Curr Opin Anaesthesiol. 2013 Feb;26(1):31-9
references.pmid: 23262471
references.citation: Br J Anaesth. 2012 Aug;109(2):191-9
references.pmid: 22710266
references.citation: BMJ. 2004 Jul 31;329(7460):258
references.pmid: 15242867
references.citation: Eur J Anaesthesiol. 2009 Jun;26(6):484-9
references.pmid: 19436173
references.citation: BMJ. 2009 Jun 24;338:b2418
references.pmid: 19553261
references.citation: J Am Coll Surg. 2006 Jun;202(6):971-89
references.pmid: 16735213
references.citation: N Engl J Med. 2003 Jan 2;348(1):5-14
references.pmid: 12510037
references.citation: Anesth Analg. 2011 Jun;112(6):1274-6
references.pmid: 21613196
references.citation: Anaesthesia. 2002 Sep;57(9):845-9
references.pmid: 12190747
references.citation: Anesth Analg. 2003 Feb;96(2):611-7, table of contents
references.pmid: 12538221
references.citation: Br J Anaesth. 2002 Jan;88(1):65-71
references.pmid: 11881887
references.citation: Crit Care. 2008;12(3):R82
references.pmid: 18570641
references.citation: Br J Surg. 2009 Apr;96(4):331-41
references.pmid: 19283742
references.citation: Curr Opin Anaesthesiol. 2012 Feb;25(1):96-101
references.pmid: 22157192
references.citation: Anesth Analg. 2005 Mar;100(3):675-682
references.pmid: 15728051
references.citation: Crit Care. 2012 May 24;16(3):R94
references.pmid: 22624531
references.citation: Ann Fr Anesth Reanim. 2013 Oct;32(10):e151-8
references.pmid: 24126197
references.citation: Br J Anaesth. 2014 Apr;112(4):648-59
references.pmid: 24413429
references.citation: J Cardiothorac Vasc Anesth. 2011 Feb;25(1):53-8
references.pmid: 20850989
references.citation: N Engl J Med. 2012 Jul 12;367(2):124-34
references.pmid: 22738085
references.citation: Lancet. 2002 May 25;359(9320):1812-8
references.pmid: 12044376
references.citation: Ann Fr Anesth Reanim. 2013 Jun;32(6):454-62
references.pmid: 23747212
references.citation: Anesthesiology. 2002 Oct;97(4):820-6
references.pmid: 12357146
references.citation: JAMA. 2013 Nov 6;310(17):1809-17
references.pmid: 24108515
references.citation: Anesth Analg. 2012 Mar;114(3):640-51
references.pmid: 22253274
references.citation: Perioper Med (Lond). 2012 Jun 27;1:2
references.pmid: 24764518
references.citation: Br J Anaesth. 2012 Jul;109(1):69-79
references.pmid: 22661747
references.citation: Minerva Anestesiol. 2011 May;77(5):545-53
references.pmid: 21540811
references.citation: Anesth Analg. 2012 Dec;115(6):1309-14
references.pmid: 23144442
references.citation: AANA J. 2009 Apr;77(2):110-4
references.pmid: 19388505
references.citation: Surgery. 2010 Apr;147(4):542-52
references.pmid: 20004445
references.citation: Anesth Analg. 2011 Nov;113(5):1058-63
references.pmid: 21965349
references.citation: Crit Care. 2006;10(6):R164
references.pmid: 17118186