Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2015; 4(3): 192-201
Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.192
Postoperative fluid management
Selami Ilgaz Kayilioglu, Tolga Dinc, Isa Sozen, Akin Bostanoglu, Mukerrem Cete, Faruk Coskun
Selami Ilgaz Kayilioglu, Tolga Dinc, Isa Sozen, Akin Bostanoglu, Mukerrem Cete, Faruk Coskun, Ankara Numune Training and Research Hospital, Department of General Surgery, 06100 Altindag, Ankara, Turkey
Author contributions: Kayilioglu SI, Dinc T and Coskun F designed the review; Kayilioglu SI, Dinc T, Sozen I, Bostanoglu A and Cete M conducted the literature review; Kayilioglu SI, Dinc T and Coskun F wrote the article; Cete M and Coskun F supervised all the process.
Conflict-of-interest statement: Authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Faruk Coskun, Professor of Surgery, Ankara Numune Training and Research Hospital, Department of General Surgery, Anafartalar Mah. Talatpasa Bul. No. 5, 06100 Altindag, Ankara, Turkey. farukcoskun@mynet.com
Telephone: +90-312-5085075 Fax: +90-312-3103460
Received: November 28, 2014
Peer-review started: November 29, 2014
First decision: January 20, 2015
Revised: February 12, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: August 4, 2015
Abstract

Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients’ status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient’s body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of over-hydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient’s actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient’s specific condition.

Keywords: Body fluids, Body fluid compartments, Fluid therapy, Intensive care, Postoperative care

Core tip: Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. Assessment of the patient’s responsiveness to fluid resuscitation should determine the need of extra volume. Due to lack of evidence that supports central venous pressure (CVP) as an indicator of body fluid needs, we should not make our fluid resuscitation decisions based on CVP levels. On the other hand dynamic measures can be used to determine patient’s fluid status. Among all fluid management strategies, goal directed strategy is the most rational approach to maintain optimum fluid balance.