Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)
Abstract
Optimal perioperative fluid management is an important component of Enhanced Recovery
After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a
continuum through the preoperative, intraoperative, and postoperative phases. Each
phase is important for improving patient outcomes, and suboptimal care in one phase
can undermine best practice within the rest of the ERAS pathway. The goal of preoperative
fluid management is for the patient to arrive in the operating room in a hydrated
and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical
bowel preparation should be avoided. Patients should be encouraged to ingest a clear
carbohydrate drink two to three hours before surgery. The goals of intraoperative
fluid management are to maintain central euvolemia and to avoid excess salt and water.
To achieve this, patients undergoing surgery within an enhanced recovery protocol
should have an individualized fluid management plan. As part of this plan, excess
crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk
surgery, a “zero-balance” approach might be sufficient. In addition, for most patients
undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended.
Ultimately, however, the additional benefit of GDFT should be determined based on
surgical and patient risk factors. Postoperatively, once fluid intake is established,
intravenous fluid administration can be discontinued and restarted only if clinically
indicated. In the absence of other concerns, detrimental postoperative fluid overload
is not justified and “permissive oliguria” could be tolerated.
Type
Journal articleSubject
Cardiac OutputCentral Venous Pressure
Fluid Therapy
Humans
Length of Stay
Perioperative Care
Recovery of Function
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https://hdl.handle.net/10161/12552Published Version (Please cite this version)
10.1007/s12630-014-0266-yPublication Info
Miller, Timothy Ellis; Roche, Anthony Michael; & Mythen, Michael Gerard (2016). Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After
Surgery (ERAS). Canadian Journal of Anesthesia, 62(2). pp. 158-168. 10.1007/s12630-014-0266-y. Retrieved from https://hdl.handle.net/10161/12552.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Timothy Ellis Miller
Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine;
with particular interests in fluid management, and perioperative optimization of the
high-risk non-cardiac surgery patient.
Michael Gerard Mythen
Adjunct Professor in the Department of Anesthesiology
Main area of research interest is the role of gut mucosal hypoperfusion in the pathogenesis
of post-operative organ dysfunction. On-going projects include: i) the effects of
temperature on gut perfusion during cardiopulmonary by-pass, ii) the relationship
between cerebral and splanchnic hypoperfusion during cardiac surgery, iii) the relationship
between gut mucosal hypoperfusion and outcome in patients admitted for surgical intensive
care, iv) the effects of enteral feeding on gut perfusion and
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