perioperative fluid and volume management physiological basis, tools and strategies围手术期液体和卷管理生理基础、工具和策略.pdf

Strunden et al. Annals of Intensive Care 2011, 1:2 /content/1/1/2 REVIEW Open Access Perioperative fluid and volume management: physiological basis, tools and strategies Mike S Strunden1,2*, Kai Heckel1,2, Alwin E Goetz1,2, Daniel A Reuter1,2 Abstract Fluid and volume therapy is an important cornerstone of treating critically ill patients in the intensive care unit and in the operating room. New findings concerning the vascular barrier, its physiological functions, and its role regarding vascular leakage have lead to a new view of fluid and volume administration. Avoiding hypervolemia, as well as hypovolemia, plays a pivotal role when treating patients both perioperatively and in the intensive care unit. The various studies comparing restrictive vs. liberal fluid and volume management are not directly comparable, do not differ (in most instances) between colloid and crystalloid administration, and mostly do not refer to the vascular barrier’s physiologic basis. In addition, very few studies have analyzed the use of advanced hemodynamic monitoring for volume management. This article summarizes the current literature on the relevant physiology of the endothelial surface layer, discusses fluid shifting, reviews available research on fluid management strategies and the commonly used fluids, and identifies suitable variables for hemodynamic monitoring and their goal-directed use. Introduction perioperative volume therapy. However, all of those There is increasing evidence that fluid management three aspects cannot be separated from each other when influences patient’s outcome as well in critical illness, as defining rational strategies for fluid management. Thus, during and after major surgery. Hence, the num