Perioperative fluid therapy: defining a clinical algorithm between insufficient and excessive

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• 作者：Mike S. Strunden ; MD ; DESA ; ^{m.strunden@asklepios.com" class="auth_mail" title="E-mail the corresponding author} ; Sascha Tank ; MD¹ ; ^{s.tank@asklepios.com" class="auth_mail" title="E-mail the corresponding author} ; Thoralf Kerner ; MD ; PhD¹ ; ^{t.kerner@asklepios.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Colloids ; Crystalloids ; Fluid therapy ; Perioperative
• 刊名：Journal of Clinical Anesthesia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：35
• 期：Complete
• 页码：384-391
• 全文大小：300 K

文摘

1. Double-barrier concept

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Double-barrier concept means primarily the endothelial surface layer constitutes the vascular barrier.

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The osmotic gradient is generated within the intact endothelial surface layer.

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The endothelial cell line is of lower priority.

2. Fluid shifting

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Type 1 shift, occuring always, is a physiological, nearly protein-free shift.

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It is only pathologic if the capacity of the lymphatic system is transgressed.

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The pathologic type 2 shift is based on vascular barrier dysfunction.

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Type 2 shift contains protein close to plasma concentrations.

3. Cardiac output

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The metabolic demands of the body are met by varying cardiac output.

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Stroke volume variation or pulse pressure variation is suitable for predicting fluid responsiveness.

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Cardiac output should be normalized with volumetric parameters in mind.

4. Colloid solutions

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Colloids are beneficial in reaching hemodynamic stability during hypovolemia.

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Low-molecular hydroxyethyl starch (130 kDa) seems not to harm renal function.

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Gelatins may cause renal injury.

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Use of albumin for volume resuscitation is neither harmful nor beneficial.