[TJS4-2] Perioperative fluid therapy
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ライブ配信】
The choice of perioperative fluid has been one of on-going controversial issues in perioperative critical care. Acute crystalloid loading and hypervolemia result in fluid overload which may be associated with organ dysfunction and increased mortality. Protection or restoration of the endothelial glycocalyx layer may be an important therapeutic goal of fluid therapy. Large observational studies show hyperchloremia was associated with increased mortality, renal dysfunction & hospital stay in surgical patients. Recent large cluster-randomized, multiple-cross over trial show balanced crystalloid solutions resulted in improved composited outcomes including mortality & major adverse renal risk compared to 0.9%NaCl in critically ill adults. Colloids have been shown to be more effective than crystalloids for intravascular volume effect and improving systemic hemodynamics. However, meta-analyses show association between hydroxyethyl starch and increased incidence of renal replacement therapy/mortality in mixed group of critically ill patients. Recent study show long-term disability-free survival was significantly higher in the colloid than crystalloid in major abdominal surgical patients. Optimizing fluid therapy with dynamic hemodynamic parameters in goal-directed hemodynamic/fluid management decreases morbidity & mortality in high risk surgical patients. Assisted fluid management strategy with tools that can suggest fluid bolus therapy & continuously re-assess the patient’s needs for further fluid may result in less fluid given but better hemodynamic profile. In summary, any perioperative fluids should be considered as drugs. Therefore, clinicians should have much more thoughtful consideration as no definitive recommendations on the most appropriate fluid of choice or how to optimize fluid therapy for every surgical patient yet.