Department of Intensive Care, Guy's & St Thomas' Hospital, London, UK; King's College London, Faculty of Life Sciences & Medicine, London, UK.
Department of Critical Care, Cleveland Clinic London, London, UK; King's College London, Faculty of Life Sciences & Medicine, London, UK.
Br J Anaesth. 2024 Dec;133(6):1263-1275. doi: 10.1016/j.bja.2024.07.038. Epub 2024 Sep 27.
Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management of surgical patients from the preoperative period until hospital discharge and for all types of elective and emergency surgery, apart from burn injuries and head and neck surgery. Where evidence was lacking, recommendations for future research were generated. Specific recommendations are made for fluid management in elective major noncardiac surgery, cardiopulmonary bypass, thoracic surgery, neurosurgery, minor noncardiac surgery under general anaesthesia, and critical illness. There are ongoing gaps in knowledge resulting in variation in practice and some disagreement with our consensus recommendations. Perioperative fluid management should be individualised, taking into account the type of surgery and important patient factors, including intravascular volume status and acute and chronic comorbidities. Recommendations are made for further research in perioperative fluid management to address important gaps.
液体治疗是围手术期管理的一个组成部分。鉴于该领域的新证据，围手术期质量倡议（POQI）召集了一次国际多专业专家会议，以针对接受手术的患者的液体管理生成基于证据的共识建议。本文总结了围手术期外科患者液体管理的建议，包括手术前阶段直至出院，以及所有类型的择期和急诊手术，但烧伤和头颈部手术除外。在缺乏证据的情况下，提出了未来研究的建议。针对择期大非心脏手术、体外循环、胸外科、神经外科、全身麻醉下小非心脏手术和危重病患者的液体管理提出了具体建议。由于知识的持续差距，导致实践中的差异和一些与我们的共识建议不一致。围手术期液体管理应个体化，考虑手术类型和重要的患者因素，包括血管内容量状态以及急性和慢性合并症。建议在围手术期液体管理方面进行进一步的研究，以解决重要的差距。
