Fluid Therapy in Thoracic Surgery: A Zero-Balance Target is Always Best!

Clinical studies including various types of surgical procedures have clearly shown an association between high perioperative fluids infusion and poor clinical outcome as expressed by composite mortality-morbidity endpoints (1-3). Overzealous fluid infusion promotes wound infections/dehiscence, anastomotic leakage and cardiac overload. Besides these quantitative aspects, fluid composition also deserves consideration since saline infusion exceeding 1.5-2L may cause hyperchloremic acidosis and colloids (e.g., hydroxyethyl starch) have been incriminated in renal damage when given in septic, trauma or other critically-ill patients (4-6).