Abstract
Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk procedures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.
Highlights
One of the primary goals of hemodynamic monitoring is to alert the health care team to an impending cardiovascular crisis before organ injury ensues; it is routinely used in this manner in the operating room during high-risk surgery
Recent studies have found that restricted postoperative IV fluid management in patients undergoing major abdominal surgery appears harmful because it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital
The results showed that pulmonary arterial catheter (PAC) utilization improves, worsens, or has no impact on morbidity or mortality, and its routine use in the majority of clinical circumstances, even in high-risk surgical and nonsurgical patients, is not warranted[12,13,14,15,16]
Summary
One of the primary goals of hemodynamic monitoring is to alert the health care team to an impending cardiovascular crisis before organ injury ensues; it is routinely used in this manner in the operating room during high-risk surgery. Intravenous fluid management has evolved from the early attempts to "run patients wet" by giving them large volumes of fluid in the hope of preventing renal failure, to more restricted regiments and goal-directed fluid therapy aiming to minimize perioperative complications. Recent studies have found that restricted postoperative IV fluid management in patients undergoing major abdominal surgery appears harmful because it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital. Several randomized controlled trials in recent years have shown that "restricting" fluid administration in patients undergoing elective abdominal surgery may result in better outcomes when compared with those receiving "standard or liberal" fluid therapy. Given the heterogeneity of the different studies regarding the amount of fluids given on each regime and the study end-points, we can only infer that maintenance of intravascular fluid balance, rather than fluid restriction, seems to be the key to a better postoperative outcome
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