Anesthesiology Department, Botucatu Medical School University of Sao Paulo State - UNESP, District of Rubiao Junior s/n, Botucatu, Sao Paulo, 18618-970 Brazil.
Valley Anesthesiology Consultants, Ltd., Department of Anesthesia and Perioperative Medicine, Banner Thunderbird Medical Center, Banner Health, Glendale, 85306 AZ USA.
Perioper Med (Lond). 2015 Apr 10;4:3. doi: 10.1186/s13741-015-0014-z. eCollection 2015.
Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered.
Based on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them.
The results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration.
We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations.
围手术期液体治疗仍然是一个备受争议的话题。其目的是在围手术期内维持或恢复有效的循环血容量。维持有效的循环血容量和血压是确保器官灌注充足的关键因素，同时避免器官低灌注或高灌注相关的风险。相对于围手术期液体治疗，有三个不可避免的结论：过度水化是有害的，水化不足是有害的，我们对患者液体状态的假设可能是不正确的。个体之间和机构之间的实践差异很大。本文的目的是明确围手术期液体选择的风险和益处，描述目前用于管理这些液体的循证方法，并最终减少围手术期液体管理的变异性。
基于上述认识，一组 72 名在液体复苏领域广为人知的研究人员，通过电子邮件受邀参加了 2011 年在芝加哥举行的一次会议，讨论围手术期液体治疗。在 72 名受邀者中，有 14 名代表 7 个国家的研究人员参加了会议，因此，国际液体优化小组（FOG）应运而生。这些研究人员合作审查了来自 162 篇不同液体复苏论文的数据，包括手术和重症监护病房患者。这篇手稿是 3 年来基于循证、讨论、分析和综合目前已知的个体液体的风险和益处以及最佳管理方法的结果。
这篇综述文章概述了有效围手术期液体管理计划的组成部分，并探讨了液体管理的生理原理和结果。
我们建议个体化选择围手术期液体和治疗。应根据预先定义的生理目标指导患者进行液体治疗。具体来说，应在患者需要增强灌注和容量反应性时给予液体。本文提供了一种通用的液体治疗方法和实用建议。
