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Contemporary Approaches to Perioperative IV Fluid Therapy

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Abstract

Background

Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management.

Method

We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations.

Results

Of 275 retrieved articles, we identified 25 articles to inform this review. “Normal” saline (0.9% sodium chloride) is not physiological and can result in sodium overload and hyperchloremic acidosis. Starch colloid solutions are not recommended in surgical patients at-risk of sepsis or renal failure. Most surgical patients can have clear fluids and/or administration of carbohydrate-rich drinks up to 2 h before surgery. An intraoperative goal-directed fluid strategy may reduce postoperative complications and reduce hospital length of stay. Regular postoperative assessment of the patient’s fluid status and requirements should include looking for physical signs of dehydration or hypovolemia, or fluid overload. Both hypovolemia and salt and water overload lead to adverse events, complications and prolonged hospital stay. Urine output can be an unreliable indicator of hydration status in the postoperative surgical patient. Excess fluid administration has been linked to acute kidney injury, gastrointestinal dysfunction, and cardiac and pulmonary complications.

Conclusion

There is good evidence supporting the avoidance of unnecessary fasting and the value of an individualized perioperative IV fluid regimen, with transition to oral fluids as soon as possible, to help patients recover from major surgery.

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Abbreviations

IV:

Intravenous

NICE:

National Institute for Health and Care Excellence

ERAS:

Enhanced Recovery After Surgery

SVV:

Stroke Volume Variation

PPV:

Pulse Pressure Variation

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Author information

Authors and Affiliations

  1. Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Commercial Road, Melbourne, VIC, 3004, Australia

    Paul S. Myles

  2. Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia

    Sam Andrews & Jonathan Nicholson

  3. Nottingham Digestive Diseases Centre, National Institute of Health Research (NIHR) Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK

    Dileep N. Lobo

  4. Smiths Medical Professor of Anaesthesia and Critical Care, National Institute of Health Research Biomedical Research Centre, University College London Hospitals, London, UK

    Monty Mythen

Authors
  1. Paul S. Myles
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  2. Sam Andrews
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  3. Jonathan Nicholson
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  4. Dileep N. Lobo
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  5. Monty Mythen
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Corresponding author

Correspondence to Paul S. Myles.

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Conflict of interest

PM, JN, SA and MM have no conflict of interest; DL has received unrestricted research funding and speaker’s honoraria from Fresenius Kabi, BBraun and Baxter Healthcare for unrelated work. He has also served on the advisory boards of Baxter Healthcare, AbbVie and Nutricia.

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Myles, P.S., Andrews, S., Nicholson, J. et al. Contemporary Approaches to Perioperative IV Fluid Therapy. World J Surg 41, 2457–2463 (2017). https://doi.org/10.1007/s00268-017-4055-y

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