Clinical Topic: Fluid management in Major Surgery

Fluid management during major surgery has been a topic of discussion for decades.  The goal of evidence based practice has produces many studies related to fluid management.  Despite the number of studies that have been published, to date there is no universal protocol recommending optimal fluid management guidelines

A review by Corcoran,T et al published in Anes Analg  (2012 Mar;114(3):640-51. Epub 2012 Jan 16) titled Perioperative fluid management strategies in major surgery: a stratified meta-analysis looked at major works that have been published in an attempt to clarify whether goal directed fluid therapy had an advantage over liberal fluid replacement during major surgery.  Those in the goal directed group had fluids administered based on hemodynamic targets.

The study reviewed databases from 1950 to 2009.  Postoperative complication such as pneumonia, pulmonary edema, time to first bowel movement and length of hospitalization were all greater in the liberal fluid group.  They found no difference in wound infection/dehiscence, myocardial infarction, renal complications or mortality.

The goal directed patients received more colloid fluids during surgery and had shorter hospitalization with fewer renal complications.  The authors concluded that the goal directed group had better outcomes than the liberal fluid group.  However, they could not state that goal directed therapy is superior to liberal fluid use.

Click here to read an abstract of the original article.