Perioperative fluid therapy for anaesthetists and intensivists

The maintenance of tissue fluid homeostasis is an essential task in perioperative care. Fluid balance, when managed accurately and safely, can influence perioperative outcomes and reduce significant patient morbidity and mortality. Surgical and critically ill patients are subjected to disrupted physiology due to a combination of hypovolaemia, systemic inflammation and local glycocalyx damage, with resulting impairment of normal fluid regulation. To optimize fluid management and achieve adequate end-organ perfusion, cardiac output monitoring methods are increasingly employed to guide perioperative fluid therapy. In recent years, the additional importance of optimizing microcirculation has been of great interest. Fasting and perioperative fluid strategies are similarly integral in fast-track surgery pathways, despite aspects pertaining to volumes and types of fluid still up for clinical debate. Fluid burden commonly exceeds volumes consciously given due to hidden volumes used in drug delivery, and the importance of comprehensive overview on fluid prescription should not be understated.