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Peri-operative Fluid Optimization

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Evidence-Based Critical Care

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Abstract

More than 230 million major surgical procedures are undertaken worldwide each year [1]. Data from the USA and Europe suggests that approximately 18 % of patients undergoing surgery will develop a major postoperative complication and 3–5 % will die before hospital discharge [1–4]. If this rate is applicable worldwide approximately 40 million patients undergoing surgery each year will die or develop a major postoperative complication. Those patients who develop a postoperative complication and survive to hospital discharge have diminished functional independence and reduced long-term survival. In a landmark study Khuri and coworkers demonstrated that survival up to 8 years after major surgery was strongly related to the development within 30 days of surgery of a major postoperative complication [4]. In this study, independent of preoperative risk, the occurrence of a 30-day complication reduced median patient survival by 69 %. In both the USA and Europe there are large variations in postoperative morbidity and mortality within healthcare systems [2, 3, 5]. Interventions that reduce the risks of postoperative death and complications, particularly in high risk patients have become a priority in perioperative medicine [6]. Interventions such as the use of perioperative beta-blockers, statins and tight glycemic control have proved disappointing [7, 8]. Pre-emptive goal-directed hemodynamic therapy (GDT) appears to be a promising approach to reduce postoperative complications and deaths.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Paul Ellis Marik

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Marik, P.E. (2015). Peri-operative Fluid Optimization. In: Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-11020-2_11

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  • DOI: https://doi.org/10.1007/978-3-319-11020-2_11

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