Fluid Management and Blood Transfusion



“Fluid or no fluid?” This is a recurring question confronting anesthesiologists caring for patients in the perioperative settings. Some of the triggers for this query include preoperative fasting state, intraoperative hypotension, and postoperative oliguria. Controversy continues regarding how clinicians should assess volume status and determine end points of fluid therapy. Blood transfusion is often equally controversial, with few exceptions. Issues surrounding fluid and blood products are especially complex in the aged patient. In this chapter, fluid management and blood transfusion therapy in the context of care of the geriatric patient will be addressed.


Geriatric Patient Fluid Responsiveness Total Body Water Fluid Management Pulse Pressure Variation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. Bilgin YM, van de Watering LM, Versteegh MI, van Oers MH, Brand A. Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications. Crit Care Med. 2010;38:546–52.PubMedCrossRefGoogle Scholar
  2. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–8.PubMedCrossRefGoogle Scholar
  3. Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients. Anesth Analg. 2009;108:513–7.PubMedCrossRefGoogle Scholar
  4. Cavallaro F, Sandroni C, Antonelli M. Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. Minerva Anestesiol. 2008;74:123–35.PubMedGoogle Scholar
  5. de Aguilar-Nascimento JE, Diniz BN, do Carmo AV, Silveira EA, Silva RM. Clinical benefits after the implementation of a protocol of restricted perioperative intravenous crystalloid fluids in major abdominal operations. World J Surg. 2009;33:925–30.PubMedCrossRefGoogle Scholar
  6. Eisenberg PR, Hansbrough JR, Anderson D, Schuster DP. A prospective study of lung water measurements during patient management in an intensive care unit. Am Rev Respir Dis. 1987;136:662–8.PubMedCrossRefGoogle Scholar
  7. Gerstle J, Shahul S, Mahmood F. Echocardiographically derived parameters of fluid responsiveness. Int Anesthesiol Clin. 2010;48:37–44.PubMedCrossRefGoogle Scholar
  8. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104:2263–8.PubMedCrossRefGoogle Scholar
  9. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409–17.PubMedCrossRefGoogle Scholar
  10. Holte K, Kehlet H. Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg. 2006;202:971–89.PubMedCrossRefGoogle Scholar
  11. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.CrossRefGoogle Scholar
  12. Kelleher CL. Disorders of water and electrolyte metabolism. In: Tallis R, Fillit H, eds. Brocklehurst’s textbook of geriatric medicine and gerontology. 6th ed. London: Churchill Livingstone; 2003:1109–17.Google Scholar
  13. Kumar A, Anel R, Bunnell E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32:691–9.PubMedCrossRefGoogle Scholar
  14. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812–8.PubMedCrossRefGoogle Scholar
  15. Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR. Postoperative fluid overload: not a benign problem. Crit Care Med. 1990;18:728–33.PubMedCrossRefGoogle Scholar
  16. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172–8.PubMedCrossRefGoogle Scholar
  17. Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care. 2000;4:282–9.PubMedCrossRefGoogle Scholar
  18. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005;103:25–32.PubMedCrossRefGoogle Scholar
  19. Nuttall GA, Stehling LC, Beighley CM, Faust RJ. Current transfusion practices of members of the american society of anesthesiologists: a survey. Anesthesiology. 2003;99:1433–43.PubMedCrossRefGoogle Scholar
  20. Onwuanyi A, Taylor M. Acute decompensated heart failure: pathophysiology and treatment. Am J Cardiol. 2007;99:25D–30D.PubMedCrossRefGoogle Scholar
  21. Oren-Grinberg A. The PiCCO Monitor. Int Anesthesiol Clin. 2010;48:57–85.CrossRefGoogle Scholar
  22. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care. Med. 2007;35:64–8.PubMedCrossRefGoogle Scholar
  23. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007:CD000567.Google Scholar
  24. Practice Guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology. 1996;84:732–47.CrossRefGoogle Scholar
  25. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198–208.CrossRefGoogle Scholar
  26. Robin E, Costecalde M, Lebuffe G, Vallet B. Clinical relevance of data from the pulmonary artery catheter. Critical Care. 2006;10:S3.PubMedCrossRefGoogle Scholar
  27. Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5–14.PubMedCrossRefGoogle Scholar
  28. Spahn DR, Chassot PG. CON: Fluid restriction for cardiac patients during major noncardiac surgery should be replaced by goal-directed intravascular fluid administration. Anesth Analg. 2006;102:344–6.PubMedCrossRefGoogle Scholar
  29. Tollofsrud S, Elgjo GI, Prough DS, Williams CA, Traber DL, Kramer GC. The dynamics of vascular volume and fluid shifts of lactated Ringer’s solution and hypertonic-saline-dextran solutions infused in normovolemic sheep. Anesth Analg. 2001;93:823–31.PubMedCrossRefGoogle Scholar
  30. van Kraaij DJ, Jansen RW, Gribnau FW, Hoefnagels WH. Diuretic therapy in elderly heart failure patients with and without left ventricular systolic dysfunction. Drugs Aging. 2000;16:289–300.PubMedCrossRefGoogle Scholar
  31. Wheeler AP, Bernard GR, Thompson BT, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354:2213–24.PubMedCrossRefGoogle Scholar
  32. Wiggins J. Changes in renal function. In: Hazzard WR, Blass JP, Halter JB, Ouslander JG, Tinetti ME, eds. Principles of geriatric medicine and gerontology. 5th ed. New York: McGraw-Hill/Professional; 2003:543–9.Google Scholar
  33. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001;345:1230–6.PubMedCrossRefGoogle Scholar
  34. Zimmermann M, Feibicke T, Keyl C, et al. Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery. Eur J Anaesthesiol. 2010;27(6):555–61.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Anesthesiology, Boston Medical CenterBoston University School of MedicineBostonUSA

Personalised recommendations