Perioperative fluid therapy: a statement from the international Fluid Optimization Group.
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BACKGROUND: Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered. METHODS: Based on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them. RESULTS: The results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration. CONCLUSIONS: We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations.
Published Version (Please cite this version)10.1186/s13741-015-0014-z
Publication InfoAuler, JOC; Bloomstone, JA; Cannesson, M; Gan, Tong Joo; Kinsky, M; Kramer, GC; ... Rocca, Giorgio Della (2015). Perioperative fluid therapy: a statement from the international Fluid Optimization Group. Perioper Med (Lond), 4. pp. 3. 10.1186/s13741-015-0014-z. Retrieved from http://hdl.handle.net/10161/12554.
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Consulting Professor in the Department of Anesthesiology
My current research interests include postoperative nausea and vomiting (PONV), acute postoperative pain, clinical pharmacology of anesthetic drugs and resuscitation fluids as well as database research in postoperative outcomes. Improving Outcome in Surgical Patients: Nausea and vomiting is regarded as one of the most unpleasant experiences in postoperative recovery. To date, there is no single antiemetic which can satisfactorily control PONV. My interests concentrate o
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Associate 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.
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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Gan, Tong Joo; Miller, Timothy Ellis; Raghunathan, Karthik (Best Pract Res Clin Anaesthesiol, 2014-09)The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence ...
American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Brudney, CS; Cannesson, M; Gan, Tong Joo; Lobo, DN; Martin, D; Miller, Timothy Ellis; Mythen, Michael Gerard; ... (12 authors) (Perioper Med (Lond), 2016)BACKGROUND: Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients undergoing ...