title: State of the art in fluid and volume therapy : A user-friendly staged concept. English version.
abstract: Adequate intraoperative infusion therapy is essential for the perioperative outcome of a patient. Both hypo- and hypervolemia can lead to an increased rate of perioperative complications and to a worse outcome. Perioperative infusion therapy should therefore be needs-based. The primary objective is the maintenance of preoperative normovolemia using a rational infusion strategy. Perioperative fluid losses should be differentiated from volume losses due to surgical bleeding or protein losses into the interstitial space. Fluid loss via urine excretion or insensible perspiration (0.5-1.0 ml/kg/h) should be replaced with balanced, isooncotic, crystalloid infusion solutions in a ratio of 1:1. Volume therapy stage 1: intraoperative volume losses up to a blood loss corresponding to 20% of the patient's total blood volume are compensated for by balanced crystalloids in a ratio of 4-5:1. Stage 2: blood losses exceeding this level are to be treated with isooncotic colloids (preferably balanced) in a 1:1 ratio. In this regard taking into consideration the contraindications, e. g., sepsis, burns, critical illness (usually patients in the intensive care unit), impaired renal function or renal replacement therapy, intracranial hemorrhage, or severe coagulopathy, artificial colloids such as hydroxyethyl starch (HES) can be used perioperatively for volume replacement. Stage 3: if an allogeneic blood transfusion is indicated, blood and blood products are applied in a differentiated manner.
authors.affiliation: Department of Anaesthesiology, LMU Munich, Marchioninistr 15, 81377, Munich, Germany. markus.rehm@med.uni-muenchen.de.
authors.forename: M
authors.initials: M
authors.lastname: Rehm
authors.affiliation: Department of Anaesthesiology, LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Hulde
authors.affiliation: Department of Anaesthesiology, LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kammerer
authors.affiliation: Department of Anaesthesiology, LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: A S
authors.initials: AS
authors.lastname: Meidert
authors.affiliation: Department of Anaesthesiology, LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hofmann-Kiefer
mesh_terms: D016063:Blood Loss, Surgical; D003102:Colloids / Q000627:therapeutic use; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D000077324:Crystalloid Solutions / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods*; D007552:Isotonic Solutions; D010952:Plasma Substitutes / Q000627:therapeutic use
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes
keywords: Colloid; Crystalloid; Hydroxyethyl starch; Infusions; Perioperative volume balance