Perioperative Fluid Management

Posted by e-Medical PPT Saturday, July 7, 2012
Goals of Fluid Administration
O2 delivery / blood flow - perfusion
Maintain electrolyte composition,
Glycemia,
Body temperature

“Classic” fluid management
Deficits
Estimate
 Preop NPO (hourly maintenance x duration)
 Preop bowel preparation (1-1.5L)
 Preop blood loss (trauma) or fluid loss (burns)
 Typically replaced over first 2-4 hours

Maintenance
Based on water loss from burning calories from Holliday and Segar

3rd Space and Blood loss
“Third space” 2-10 ml/kg/hr
Blood losses:
3 to 1 ratio of crystalloid to EBL
1 to 1 for colloid or blood
(or hypertonic saline)

Surgical Trauma: Third Spacing
Capillary and Endothelial injury; leak
Sequestration of fluid into tissues
i.e. TRAUMA causes FLUID Retention

Creation of nonfunctional component of ISF
Return of fluid from this ‘third space’ 1-4 days after surgery

Risks of Excess Fluids
Interstitial edema
Impaired cellular metabolism
Poor wound healing
Decreased pulmonary compliance
Heart failure – overload
Delayed return of bowel function
Hemodilution
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