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Related Experiment Video

Updated: Mar 11, 2026

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
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Perioperative fluid therapy: defining a clinical algorithm between insufficient and excessive.

Mike S Strunden1, Sascha Tank1, Thoralf Kerner1

  • 1Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy, Asklepios Klinikum Harburg (Asklepios Medical Centre Harburg), Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany.

Journal of Clinical Anesthesia
|November 23, 2016
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Summary

Perioperative fluid and volume therapy remains challenging. This review explores the physiological basis of fluid loss and proposes a rational algorithm for effective fluid replacement in surgical patients.

Keywords:
ColloidsCrystalloidsFluid therapyPerioperative

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Area of Science:

  • Anesthesiology and Critical Care Medicine
  • Surgical Physiology
  • Hemodynamics

Background:

  • Adequate fluid and volume therapy is crucial but challenging in the perioperative setting.
  • Existing research on fluid management often yields conflicting results due to varied patient groups, surgical types, and therapeutic approaches.
  • Understanding the physiological basis of vascular barrier function is key to optimizing fluid therapy.

Purpose of the Study:

  • To elucidate the physiological reasons for perioperative fluid loss from the vasculature.
  • To identify the destinations of this fluid extravasation.
  • To propose a rational, evidence-based fluid replacement algorithm for clinical implementation.

Main Methods:

  • Review of current physiological understanding of vascular barrier function.
  • Analysis of pathophysiological disturbances during the perioperative period.
  • Synthesis of findings to address key questions regarding fluid loss and replacement.

Main Results:

  • Identifies the physiological mechanisms driving perioperative fluid extravasation.
  • Details the common sites and reasons for fluid loss.
  • Provides a framework for a rational fluid replacement strategy.

Conclusions:

  • A deeper understanding of perioperative fluid dynamics is essential for effective patient management.
  • Implementing a physiologically-based fluid replacement algorithm can improve clinical outcomes.
  • Further research should focus on standardizing fluid therapy protocols based on physiological principles.