Deslarzes Philip, Jurt Jonas, Larson David W, Blanc Catherine, Hübner Martin, Grass Fabian
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1005 Lausanne, Switzerland.
Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Clin Med. 2024 Jan 30;13(3):801. doi: 10.3390/jcm13030801.
The present review discusses restrictive perioperative fluid protocols within enhanced recovery after surgery (ERAS) pathways. Standardized definitions of a restrictive or liberal fluid regimen are lacking since they depend on conflicting evidence, institutional protocols, and personal preferences. Challenges related to restrictive fluid protocols are related to proper patient selection within standardized ERAS protocols. On the other hand, invasive goal-directed fluid therapy (GDFT) is reserved for more challenging disease presentations and polymorbid and frail patients. While the perfusion rate (mL/kg/h) appears less predictive for postoperative outcomes, the authors identified critical thresholds related to total intravenous fluids and weight gain. These thresholds are discussed within the available evidence. The authors aim to introduce their institutional approach to standardized practice.
本综述讨论了术后加速康复（ERAS）路径中的限制性围手术期液体方案。由于缺乏关于限制性或开放性液体管理方案的标准化定义，因为它们取决于相互矛盾的证据、机构方案和个人偏好。与限制性液体方案相关的挑战与在标准化ERAS方案中正确选择患者有关。另一方面，有创目标导向液体治疗（GDFT）则适用于更具挑战性的疾病表现以及患有多种疾病和身体虚弱的患者。虽然灌注率（毫升/千克/小时）对术后结果的预测性似乎较低，但作者确定了与总静脉输液量和体重增加相关的临界阈值。这些阈值将在现有证据范围内进行讨论。作者旨在介绍他们机构的标准化实践方法。
