Postoperative fluid management

Abstract

Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients’ status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient’s body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of over-hydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient’s actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient’s specific condition.

Keywords: Body fluids; Body fluid compartments; Fluid therapy; Intensive care; Postoperative care

Core tip: Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. Assessment of the patient’s responsiveness to fluid resuscitation should determine the need of extra volume. Due to lack of evidence that supports central venous pressure (CVP) as an indicator of body fluid needs, we should not make our fluid resuscitation decisions based on CVP levels. On the other hand dynamic measures can be used to determine patient’s fluid status. Among all fluid management strategies, goal directed strategy is the most rational approach to maintain optimum fluid balance.