Management of fluid balance

Abstract

Managing fluid balance mandates a clear identification of what goals are being sought at a particular point in the patient's pathway, an accurate assessment of both filling status and the degree of tissue hypoperfusion (if present), and a precise evaluation of response. As no definitive data exist to show how the above targets should be optimally achieved, and with what fluid, many opinions of varied veracity currently exist. A perception from recent surveys is that critical care and intraoperative patients in Europe are more likely to receive synthetic colloid as the primary resuscitation fluid and to have cardiac output monitored by noninvasive or minimally invasive monitoring techniques. However, these preferences are based largely on tradition and local technology developments, albeit with an increasing evidence base for high-risk surgery. There is an increasing consensus that excess fluid should be avoided and that, after the initial resuscitation phase, efforts should be made to keep the patient in neutral (or perhaps negative) balance, unless clinically indicated. Likewise, the intravascular compartment should not remain underfilled if tissue hypoperfusion exists, acknowledging the above difficulties in agreeing upon definition and diagnosis. Achieving and maintaining optimal fluid balance remains a significant challenge; better monitoring tools and definitive studies are needed.