Perioperative fluid therapy: a statement from the international Fluid Optimization Group.
Abstract
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.
Type
Journal articlePermalink
https://hdl.handle.net/10161/12554Published Version (Please cite this version)
10.1186/s13741-015-0014-zPublication Info
Auler, 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 https://hdl.handle.net/10161/12554.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.
Collections
More Info
Show full item recordScholars@Duke
Tong Joo Gan
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.
Timothy Ellis Miller
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.
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
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Related items
Showing items related by title, author, creator, and subject.
-
State-of-the-art fluid management in the operating room.
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 ... -
A New Method for Modeling Free Surface Flows and Fluid-structure Interaction with Ocean Applications
Lee, Curtis (2016)The computational modeling of ocean waves and ocean-faring devices poses numerous challenges. Among these are the need to stably and accurately represent both the fluid-fluid interface between water and air as well as the ...