[Perioperative Strategy of Fluid and Nutrition in the Compromised Patients After Lung Resection]

The strategy for the administration of fluid and nutrition management after lung resection is not unusual, as compared to the other ordinal surgeries. However, it should be kept in mind that relative reduction in right ventricular function could occur following lung resection due to increased pulmonary vascular resistance. The surgical trauma such as pulmonary arterial clamp and lymphadenectomy as well as the removal of the lung, and perioperative factors such as single lung ventilation, could also increase pulmonary vascular resistance, all of which could be related to acute lung injury. Regarding the fluid management, excessive fluid administration could cause pulmonary edema, decreased alveolar gas permeability, atelectasis, and hypoxia, while restrictive fluid management could induce complication related to hypoperfusion. Since these adverse effects are highly associated with the main causes of morbidity and mortality particularly in the compromised patients, a proper assessment and monitoring of fluid balance (fluid optimization) would be required. In addition, along with the increasing number of the elderly patients, particular concerns must be given to the patients with the sarcopenia or frailty. The appropriate nutritional support following lung surgery is necessary to reduce surgical morbidity and morbidity especially for the malnourished and elderly patients.