The Effects of Fluid Optimization on Outcome Following Major Surgery

SUMMARY The appropriate administration of intravenous fluid therapy to maintain an effective circulating volume and prevent inadequate tissue perfusion is a core element of the perioperative practice of anesthesia. The choice of fluid in a variety of different clinical situations can now be rationally guided by an understanding of the physicochemical and biological properties of the crystalloid and colloid solutions available. Deciding how much fluid to give has traditionally been more controversial. Fluid therapy should be titrated to rational physiological end‐points, directed by appropriate cardiovascular monitoring. Goal‐directed “optimization” of intravascular volume and organ blood flow aims to ensure adequate tissue perfusion and cellular oxygenation. There is a substantial body of literature demonstrating that mortality following major surgery can be significantly reduced by goal‐directed approaches to perioperative hemodynamic management. This literature will be reviewed and implications for current anesthetic practice discussed.