Liberal or Restricted Fluid Administration

Are We Ready for a Proposal of a Restricted Intraoperative Approach?

Giorgio Della Rocca; Luigi Vetrugno; Gabriella Tripi; Cristian Deana; Federico Barbariol; Livia Pompei

BMC Anesthesiol. 2014;14(62)

Abstract and Introduction

Abstract

Background Fluid management in the perioperative period has been extensively studied but, despite that, "the right amount" still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today.

Discussion In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence.

Summary An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution.

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Abstract and Introduction
Background
Discussion
Summary
References

Table 1. Heterogeneous protocol
	Liberal	Restricted
Holte et al. [3]	30 mL/Kg/h	10 mL/Kg/h
Holte et al. [4]	18 mL/Kg/h RL + 7 mL/Kg/h HES 130/0.4	5–7 mL/Kg/h RL + 7 mL/Kg/h HES 130/0.4
Abraham-Nordling M. et al. [5]	5 mL/Kg/h RL + 2 mL Gluc 2.5%	2 mL/Kg/h Gluc 2.5%
Lobo S. et al. [6]	12 mL/Kg/h RL	5 mL/Kg/h RL