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Positive Fluid Balance and Patients’ Outcomes

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Perioperative Fluid Management

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Abstract

A large percentage of hospitalized patients are readmitted within 90 days of discharge with heart failure. Emerging observational data suggest that positive fluid balance that occurs during the hospitalization, particularly among patients at risk for fluid retention, is associated with poor outcomes. Consequently, careful and judicious attention to both fluid administration and to overall fluid balance during the hospital stay is important. To this end, understanding the physiology of the distribution of body fluid compartments, and that both the arterial and the venous aspects of the vascular space are independently important, is critical to patient care. In this chapter, we will review the clinical data outlining the potential risk of positive fluid balance and the physiological mechanisms that might influence the physician’s decision whether to administer intravenous fluid or diuretics. Ultimately, despite a large amount of data highlighting the potential risks of excess fluid during a hospital stay, well-designed trials that use diuretics to reestablish euvolemia upon discharge are needed to further guide management.

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  1. Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    John Danziger MD, MPhil

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  1. John Danziger MD, MPhil
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Correspondence to John Danziger MD, MPhil .

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  1. Cleveland Clinic Lerner College of Medicine Director of Clinical Research Staff Anesthesiologist General Anesthesia and Outcomes Research Cleveland Clinic, Cleveland, Ohio, USA

    Ehab Farag

  2. Cleveland Clinic Lerner College of Medicine Chairman of General Anesthesia Cleveland Clinic, Cleveland, Ohio, USA

    Andrea Kurz

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Danziger, J. (2016). Positive Fluid Balance and Patients’ Outcomes. In: Farag, E., Kurz, A. (eds) Perioperative Fluid Management. Springer, Cham. https://doi.org/10.1007/978-3-319-39141-0_12

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