Restricted, optimized or liberal fluid strategy in thoracic surgery: A narrative review

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Perioperative fluid balance significantly impacts patient outcomes, especially in thoracic surgery where fluid overload risk is high.
• Pulmonary complications are linked to fluid shifts and endothelial glycocalyx integrity.
• Modern surgical practices involve shorter fasting and earlier oral intake post-surgery.

Purpose of the Study:

• To review current understanding of fluid management in thoracic surgery.
• To discuss strategies for maintaining fluid homeostasis and adequate tissue oxygen delivery.
• To highlight the role of hemodynamic monitoring and fluid therapy in preventing complications.

Main Methods:

• Review of current literature on perioperative fluid management in thoracic surgery.
• Discussion of normovolemic therapy and goal-directed hemodynamic therapy.
• Emphasis on the use of hemodynamic monitors and cardiovascular drugs.

Main Results:

• Fluid overload increases the risk of acute respiratory distress syndrome and other complications in thoracic surgery patients.
• Normovolemic therapy or goal-directed hemodynamic therapy with limited fluid intake (around 1 liter) and cardiovascular support is recommended.
• Hemodynamic monitors aid in assessing volume responsiveness and guiding fluid and drug therapy.

Conclusions:

• Fluid administration in thoracic surgery should be individualized, like a drug prescription, considering patient needs and surgical context.
• Avoiding excessive fluid intake is key to preventing pulmonary edema and enhancing recovery.
• Further randomized clinical trials are needed to resolve debates on optimal fluid strategies and types (crystalloids vs. colloids).