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Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).

dc.contributor.author Miller, Timothy Ellis
dc.contributor.author Roche, Anthony Michael
dc.contributor.author Mythen, Michael Gerard
dc.coverage.spatial United States
dc.date.accessioned 2017-04-06T19:56:23Z
dc.date.available 2017-04-06T19:56:23Z
dc.date.issued 2015-02
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/25391735
dc.identifier.uri https://hdl.handle.net/10161/13966
dc.description.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.
dc.language eng
dc.relation.ispartof Can J Anaesth
dc.relation.isversionof 10.1007/s12630-014-0266-y
dc.subject Cardiac Output
dc.subject Central Venous Pressure
dc.subject Fluid Therapy
dc.subject Humans
dc.subject Length of Stay
dc.subject Perioperative Care
dc.subject Recovery of Function
dc.title Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/25391735
pubs.begin-page 158
pubs.end-page 168
pubs.issue 2
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, General, Vascular, High Risk Transplant & Critical Care
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 62
dc.identifier.eissn 1496-8975


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