Fluid management in thoracic surgery

This review presents the current available data to date regarding the perioperative risks associated with fluid management in thoracic surgery and its implications on the development of acute lung injury (ALI) as well as acute kidney injury (AKI).

The debate over the adequate fluid management during lung resection surgery has not been settled. Recent findings question the relationship between fluid administration and the development of ALI after lung resection surgery. New concepts including the capillary glycocalyx and the 'baby lung' model have reshaped thinking and therapy. Currently, there has been a growing interest in tissue hypoperfusion resulting from inadequate fluid resuscitation and the development of AKI after lung resection surgery.

Alternative fluid regimens to the traditional restrictive protocols used during thoracic surgery are being explored. These include normovolemic and goal-directed therapy protocols and the use of newer colloid solutions.