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Perioperative Fluid Management Ehab Farag · Andrea Kurz Editors Perioperative Fluid Management 123 Perioperative Fluid Management Ehab Farag • Andrea Kurz Editors Perioperative Fluid Management Editors Ehab Farag Andrea Kurz Professor of Anesthesiology Professor of Anesthesiology Cleveland Clinic Lerner College of Medicine Cleveland Clinic Lerner College of Medicine Director of Clinical Research Chairman of General Anesthesia Staff Anesthesiologist Cleveland Clinic General Anesthesia and Outcomes Research Cleveland Cleveland Clinic Ohio Cleveland USA Ohio USA ISBN 978-3-319-39139-7 ISBN 978-3-319-39141-0 (eBook) DOI 10.1007/978-3-319-39141-0 Library of Congress Control Number: 2016955238 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland The registered company address is Gewerbestrasse 11, 6330 Cham, Switzerland To my daughter Becky for her compassionate, listening ear, and assistance in many of my publications. – Ehab Farag Foreword Perioperative fl uid management has been a debated topic for decades within the anesthesia, surgical, and critical care literature. The “classic” approach to fl uid administration was based upon the duration of fasting, patient weight, duration of surgery, and extent of tissue disturbance. The high degree of evolution that has occurred on this topic is evidenced by perusing the contents of this book. Drs. Ehab Farag and Andrea Kurz have assembled an incredible group of recog- nized authorities and experts in this fi eld. Collectively, they have amassed one of the world’s most comprehensive collections of evidence-based literature that supports the newest concepts and approaches to perioperative fl uid management. Yet this book also provides a true historical perspective, beginning with the contribution of Dr. Elizabeth Frost, followed by chapters on the revised Starling principle and func- tions of endothelial glycocalyx. The content of this book is deep and broad in dis- cussing all aspects of perioperative fl uid management, thorough, and comprehensive. No “stone is left unturned” in this discussion. I have no doubt that this book will be used as a great reference for other academic endeavors in this fi eld, making it a “must read” and necessary inclusion to the library of every anesthesiologist, surgeon, and critical care physician caring for perioperative patients. The overall design of this book is two parts. The fi rst part covers the overall pro- cess, techniques for monitoring and management, restricted vs liberal administra- tion strategies, crystalloid vs colloid, patient outcome, and the role of fl uid management in enhanced recovery protocols. The second part provides a case-based approach to fl uid management in specifi c patient scenarios, broadly characterized as abdominal, orthopedic, neurological, and septic shock. The topic of perioperative fl uid management has important implications on mor- bidity, mortality, enhanced recovery, and perioperative outcomes. This book comes at a time when fi nancial pressures are closely linked to patient outcomes with the evolution of bundled-payment models. A rational, evidenced-based, best practice approach to fl uid management can have a signifi cant impact upon overall patient outcomes and hence is a topic worthy of complete understanding in the manner in vii viii Foreword which Drs. Farag and Kurz have undertaken. They are to be congratulated for their outstanding contribution to the literature. On a personal note, I am proud to be associated with the many authors of this book who work at the Cleveland Clinic. Their outstanding contributions to this text- book are a testament of their dedication and daily contribution toward patient care that allows our institution to care for a wide variety of critically ill patients within many surgical subspecialty areas. Their collaborative approach to this book illus- trates the way they “act as a unit” with other physicians in the perioperative care of our patients within a clinical approach that truly puts “patients fi rst.” Christopher A. Troianos , MD, FASE Chair, Anesthesiology Institute Cleveland Clinic Cleveland , OH , USA Pref ace With the establishment of the society of microcirculation in the 1980s, our under- standing of microcirculation and tissue perfusion has fundamentally changed. The discovery of functions of endothelial glycocalyx and its essential role in maintain- ing the intact vascular barrier by Professors Curry and Michel has led to a new era in perioperative fl uid management. The Starling Principle that was considered sine qua non for governing tissue perfusion since the 1920s and was written on a tablet of stone in medical textbooks was built on a false assumption of the structure of the blood vessels. Therefore, the Revised Startling Principle has replaced it, thanks to Drs. Curry and Michel’s work in the fi eld of microcirculation. The concept of liberal perioperative fl uid management to compensate for the third space fl uid loss was shown to increase the incidence of mortality and morbidity, especially in critically ill patients. The restrictive fl uid management that properly should be named “nor- movolemic fl uid management” has become an integral part of the enhanced recov- ery after surgery to improve the patients’ perioperative outcomes. In this fi rst edition of the Perioperative Fluid Management book, we tried our best to present the most comprehensive coverage of the most recent evidence-based medicine of fl uid man- agement written by world-renowned experts in the fi eld. The book chapters cover different facets of fl uid management, such as the history of intravenous fl uid, goal- directed fl uid management, balanced and unbalanced solutions, the dilemma with the use of hydroxyethyl starch solutions, the perioperative use of albumin, the effect of fl uid overload on perioperative mortality and morbidity, and many more. We are honored to have the chapters for revised Starling Principle and endothelial glycoca- lyx written by the founding fathers of the modern science of microcirculation Drs. Curry and Michel who rewrote the story of the science of this fi eld. Moreover, we added case scenarios for fl uid management in different clinical settings to help guide the fl uid management in a practical way. We would like this book to benefi t the understanding and fl uid management of perioperative physicians. ix x Preface At the end, we would like to express our gratitude to our colleagues who authored the book chapters for their efforts and hard work. In addition, we would like to thank Ms. Maureen Pierce our developmental editor and the Springer publishing team for all their help and support during the publishing process of this book. Cleveland, OH Ehab Farag , MD, FRCA Andrea Kurz , MD Contents Part I Fundamentals of Fluid Management 1 A History of Fluid Management . 3 Elizabeth A. M. Frost 2 The Revised Starling Principle and Its Relevance to Perioperative Fluid Management . 31 C. Charles Michel , Kenton P. Arkill , and FitzRoy E. Curry 3 The Functions of Endothelial Glycocalyx and Their Effects on Patient Outcomes During the Perioperative Period. A Review of Current Methods to Evaluate Structure-Function Relations in the Glycocalyx in Both Basic Research and Clinical Settings . 75 FitzRoy E. Curry , Kenton P. Arkill , and C. Charles Michel 4 Techniques for Goal-Directed Fluid Management . 117 Paul E. Marik 5 The Perioperative Use of Echocardiography for Fluid Management . 143 Maged Argalious 6 Microcirculatory Blood Flow as a New Tool for Perioperative Fluid Management . 159 Daniel De Backer 7 Mean Systemic Filling Pressure Is an Old Concept but a New Tool for Fluid Management . 171 Hollmann D. Aya and Maurizio Cecconi 8 Restricted or Liberal Fluid Therapy . 189 Thomas E. Woodcock 9 The Perioperative Use of Albumin . 215 Ehab Farag and Zeyd Y. Ebrahim xi xii Contents 10 The Dilemma for Using Hydroxyethyl Starch Solutions for Perioperative Fluid Management . 235 Christiane S. Hartog and Konrad Reinhart 11 Balanced Versus Unbalanced Salt Solutions in the Perioperative Period . 257 Sheldon Magder 12 Positive Fluid Balance and Patients’ Outcomes . 279 John Danziger 13 Fluid Management and Its Role in Enhanced Recovery . 299 Andrew F. Cumpstey , Michael P. W. Grocott , and Michael (Monty) G. Mythen Part II Case Scenarios Management During Colorectal, Orthopedic, and Spine Cases 14 Case Scenario for Perioperative Fluid Management in Major Orthopedic Surgery . 325 Wael Ali Sakr Esa 15 Case Scenario for Perioperative Fluid Management for Major Colorectal Surgery . 335 Kamal Maheshwari 16 Case Scenario for Fluid Therapy in Septic Shock . 349 William Phillips 17 Case Scenario for Fluid Management in Liver Resection . 361 Maged Argalious and Harendra Arora 18 Case Scenario for Fluid Management During Major Spine Surgery . 369 Verna L. Baughman 19 Case Scenario for Fluid Management After Subarachnoid Hemorrhage in the Neuro- intensive Care Unit . 391 Jamil R. Dibu and Edward M. Manno Index .
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