Articles: hypovolemia-prevention-control.
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The ultimate purpose of fluid administration in states of hypovolemia is to correct cardiac output to improve microcirculatory perfusion and tissue oxygenation. Observation of the microcirculation using handheld microscopes gives insight into the nature of convective and diffusive defect in hypovolemia. The purpose of this article is to introduce a new platform for hemodynamic-targeted fluid therapy based on the correction of tissue and microcirculatory perfusion assumed to be at risk during hypovolemia. ⋯ We hypothesized that the optimal amount of fluid needed for correction of hypovolemia is defined by a physiologically based functional microcirculatory hemodynamic platform where convection and diffusion need to be optimized. Future clinical trials using handheld microscopes able to automatically evaluate the microcirculation at the bedside will show whether such a platform will indeed optimize fluid therapy.
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Using perioperative goal-directed therapy (GDT) or peroperative hemodynamic optimization significantly reduces postoperative complications and risk of death in patients undergoing noncardiac major surgeries. In this review, we discuss the main changes in the field of perioperative optimization over the last few years. ⋯ GDT is safe and more likely to tailor the amount of fluids given to the amount of fluids actually needed. This approach includes assessment of fluid responsiveness and, if necessary, the use of inotropes; moreover, this approach can be coupled with a restrictive strategy for maintenance fluids. These strategies have been increasingly incorporated into protocols for perioperative hemodynamic optimization in high-risk patients undergoing major surgery, resulting in more appropriate use of fluids, vasopressors, and inotropes.
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This article outlines the challenges of identification and management of tissue hypoperfusion as a consequence of haemorrhagic shock in civilian polytrauma cases. It also describes damage resuscitation, but does not cover specific trauma cases such as pregnancy, burns, head injuries, children and elderly trauma.
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Acta Anaesthesiol Scand · Mar 2007
ReviewMonitoring of peri-operative fluid administration by individualized goal-directed therapy.
In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess the use of strategies, parameters and monitors for goal-directed therapy. ⋯ Goal-directed therapy with the maximization of flow-related haemodynamic variables reduces hospital stay, PONV and complications, and facilitates faster gastrointestinal functional recovery. So far, oesophageal Doppler is recommended, but other monitors are available and call for evaluation.
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Intraoperative fluid management for the pediatric surgical patient is a critical element of the anesthetic care plan. In contrast with adult patients, the fluid management is systematized by the use of established protocols that calculate fluid on a per kilogram basis. Children are relatively volume sensitive, and mismanagement of fluid and electrolytes can contribute to morbidity and mortality in infants and young children undergoing even the simplest procedures. ⋯ Inappropriate overhydration can result in pulmonary edema and respiratory problems that can prove fatal. Regardless of the fluid management plan, perioperative fluid management must be flexible and take into account the physiologic development and age of the pediatric patient. The goals of intraoperative fluid management are to restore intravascular volume, maintain cardiac output, and, ultimately, ensure provision of oxygen to the tissues.