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Microcirculatory Blood Flow as a New Tool for Perioperative Fluid Management

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Perioperative Fluid Management

Abstract

Microcirculatory alterations often occur in the perioperative setting under the influence of multiple factors including hypovolemia, impaired cardiac function, vasoplegia, anesthetic agents, surgical trauma, ischemia/reperfusion injury and sepsis. The severity and duration of these alterations has been related to the outcome of these patients. This systematic review will report to which extend these microvascular abnormalities can be affected by fluid administration.

Administration of fluids usually improves microvascular dysfunction by increasing the perfused capillary density. Importantly, there is an important variability among the patients. Timing of the intervention has a huge impact as early interventions often led to an improved microvascular perfusion while delayed intervention often fails to improve the microcirculation. Of note the impact of fluids on the microcirculation is relatively dissociated form its systemic effects and can thus not be predicted by changes in cardiac output or blood pressure. Changes in lactate or in veno-arterial PCO2 gradients can be useful to indirectly evaluate the microvascular effects of fluids. Even though colloids are often associated with greater effects than crystalloids in experimental settings, this has not been confirmed in patients. Finally the impact of red blood cell transfusions is highly variable and may depend on the severity of microvascular alterations at baseline.

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Author information

Authors and Affiliations

  1. Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium

    Daniel De Backer

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  1. Daniel De Backer
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Correspondence to Daniel De Backer .

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Editors and Affiliations

  1. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Ehab Farag

  2. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Andrea Kurz

  3. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Christopher Troianos

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Backer, D.D. (2020). Microcirculatory Blood Flow as a New Tool for Perioperative Fluid Management. In: Farag, E., Kurz, A., Troianos, C. (eds) Perioperative Fluid Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48374-6_7

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  • DOI: https://doi.org/10.1007/978-3-030-48374-6_7

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-48374-6

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