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Fluid management in the septic peri-operative patient
Prashant Nasa1, Robert Wise2,3,4, Manu L N G Malbrain5,6,7
1Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK.
Current Opinion in Critical Care
|September 9, 2024
Summary
Optimizing fluid resuscitation for septic peri-operative patients is key. Personalized, goal-directed therapy using balanced solutions improves outcomes and reduces complications.
Area of Science:
- Critical care medicine
- Anesthesiology
- Surgical outcomes
Background:
- Peri-operative sepsis poses significant risks, with fluid management being a critical but complex aspect.
- Both under- and over-hydration negatively impact surgical and clinical outcomes in these patients.
- Endothelial glycocalyx (EG) damage during anesthesia and sepsis increases vascular permeability, complicating fluid management.
Purpose of the Study:
- To review current clinical studies on fluid management in septic peri-operative patients.
- To identify knowledge gaps in safe fluid resuscitation strategies.
- To optimize peri-operative outcomes and reduce complications through enhanced understanding.
Main Methods:
- Review of recent clinical studies on fluid management in septic peri-operative patients.
- Analysis of factors affecting fluid kinetics, including anesthesia type and sepsis.
- Evaluation of different fluid resuscitation strategies and solutions.
Main Results:
- Adverse outcomes are linked to both inadequate and excessive fluid administration.
- Sepsis and anesthesia can damage the endothelial glycocalyx, increasing fluid extravasation.
- Personalized, goal-directed fluid therapy (GDFT) with balanced solutions (BS) appears safer than 0.9% saline, potentially reducing mortality.
Conclusions:
- Optimized peri-operative fluid management is essential for septic patients.
- Individualized GDFT using BS is the recommended approach for fluid resuscitation.
- Further research is needed on anesthesia's impact on EG and GDFT efficacy in septic patients.
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