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- Fluid management in perioperative and critically ill patients
- Dongho Kang, Kyung Yeon Yoo
- Acute Crit Care. 2019;34(4):235-245. Published online November 29, 2019
- DOI: https://doi.org/10.4266/acc.2019.00717
- 26,698 View
- 1,195 Download
- 18 Web of Science
- 19 Crossref
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Abstract
PDF - Fluid therapy to restore and/or maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. Kinetic analyses and outcome-oriented studies have provided more insight into fluid management. Crystalloids are slowly distributed to the interstitial space, and the efficiency (proportion of infused fluid retained in the bloodstream) is 50%−75% as long as infusion continues and may increase up to 100% when the arterial pressure has decreased. Elimination of the infused fluid during general anesthesia and surgery is very slow, amounting to only 10%–20% compared with that in conscious patients. When the endothelial glycocalyx layer is degraded in sepsis or trauma-induced systemic inflammation, turnover of colloids and crystalloids is accelerated and the efficiency is reduced, which may lead to tissue edema, inflammation, poor wound healing, and organ dysfunction. Balanced crystalloids are pragmatic initial resuscitation fluids and improve patient outcomes compared to saline (0.9% sodium chloride). Albumin may be beneficial, but other synthetic colloids appear to increase the risk of acute kidney injury and death among patients in the intensive care unit. Fluid kinetics is likely to change based on patient physiological conditions (e.g., general anesthesia, surgery, stress, dehydration, blood pressure, or inflammation) and fluid types. To maximize efficacy and minimize iatrogenic side effects, fluids should be prescribed based on individual patient factors, disease states, and other treatment remedies.
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Citations
Citations to this article as recorded by
- Augmenting large language models with clinical knowledge graph for personalized perioperative fluid therapy question answering
Jie Song, Jinhua Feng, Yuxin Zhang, Cheng Bi, Xin Zheng, Zhichuan Xu, Jiale Du, Mengqiao He, Meng Xiao, Xiaoran Li, Qiongfang Cao, Chi Zhang, Hao Yang, Rongrong Wu, Bairong Shen, Hisham Al-Obaidi
PLOS Digital Health.2026; 5(6): e0001474. CrossRef - Bridging the Evidence–Practice Gap in Early Burn Injury Care: A Comprehensive Evidence Synthesis of Global Guidelines, Consensus, and Systematic Reviews for Resource-Limited Settings
Hongyu Tang, Shenjing Yu, Rui Zhang, Zheng Zhu, Li Gui
European Burn Journal.2026; 7(2): 34. CrossRef - Predictive Factors Aiding in the Estimation of Intraoperative Resources in Gastric Cancer Oncologic Surgery
Alexandru Blidișel, Mihai-Cătălin Roșu, Andreea-Adriana Neamțu, Bogdan Dan Totolici, Răzvan-Ovidiu Pop-Moldovan, Andrei Ardelean, Valentin-Cristian Iovin, Ionuț Flaviu Faur, Cristina Adriana Dehelean, Sorin Adalbert Dema, Carmen Neamțu
Cancers.2025; 17(12): 2038. CrossRef - Intraoperative Polyuria as a Possible Complication of Anesthetic Agents and Spinal Procedures: A Case Series
Nikolas A Georgakis, Nicholas Goeman, Amit Aggarwal, Husong Li
Cureus.2025;[Epub] CrossRef - Development and implementation of a multifaceted strategy to reduce excessive fasting in an acute surgical setting using the behavior change wheel framework
Sharon Carey, Rachel Hardy, Kiah Waller
Nutrition in Clinical Practice.2025; 40(6): 1457. CrossRef - The incidence and risk factors of proximal lower extremity deep vein thrombosis without pharmacologic prophylaxis in critically ill surgical Taiwanese patients: A prospective study
Ting-Lung Lin, Wen-Hao Liu, Wei-Hung Lai, Ying-Ju Chen, Po-Hsun Chang, I-Ling Chen, Wei-Feng Li, Yueh-Wei Liu, Eric J Ley, Chih-Chi Wang
Journal of the Intensive Care Society.2024; 25(2): 140. CrossRef - Pulse pressure variation guided goal-direct
fluid therapy decreases postoperative complications in elderly patients undergoing
laparoscopic radical resection of colorectal cancer: a randomized controlled
trial
Qiu-Rong Wu, Zi-Zuo Zhao, Ke-Ming Fan, Hui-Ting Cheng, Bin Wang
International Journal of Colorectal Disease.2024;[Epub] CrossRef - Assessment of the emergency surgical patient
Yuen Diana Heung Fung, Cheng Vicky Wing Kei
Anaesthesia & Intensive Care Medicine.2024; 25(8): 526. CrossRef - Research Progress on Monitoring Parameters and Techniques for Goal-Directed Fluid Therapy
博锐 闫
Advances in Clinical Medicine.2024; 14(10): 152. CrossRef - Principle of intravenous fluid therapy in the neurocritically ill patients
Sang-Bae Ko
Journal of Neurocritical Care.2024; 17(2): 41. CrossRef - Prevalence and associated factors of postoperative orthostatic intolerance at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022: cross sectional study
Negesse Zurbachew Gobezie, Nigussie Simeneh Endalew, Hailu Yimer Tawuye, Habtu Adane Aytolign
BMC Surgery.2023;[Epub] CrossRef - Remimazolam and serious adverse events
Sander Kempenaers, Tom G. Hansen, Marc Van de Velde
European Journal of Anaesthesiology.2023; 40(11): 841. CrossRef - Meropenem pharmacokinetics in critically ill patients with or without burn treated with or without continuous veno‐venous haemofiltration
Daniel J. Selig, Kevin S. Akers, Kevin K. Chung, Kaitlin A. Pruskowski, Jeffrey R. Livezey, Elaine D. Por
British Journal of Clinical Pharmacology.2022; 88(5): 2156. CrossRef - Does perioperative fluid management affect the development of postoperative complications in major gastrointestinal tract surgery? A retrospective cohort study
Mehmet Mustafa ALTINTAŞ, Kemal Tolga SARAÇOĞLU, Aytaç Emre KOCAOĞLU, Fırat MÜLKÜT, Ayten SARACOĞLU, Selçuk KAYA, Ayhan ÇEVİK
Journal of Surgery and Medicine.2022; 6(2): 90. CrossRef - A Porcine Sepsis Model With Numerical Scoring for Early Prediction of Severity
Attila Rutai, Bettina Zsikai, Szabolcs Péter Tallósy, Dániel Érces, Lajos Bizánc, László Juhász, Marietta Zita Poles, József Sóki, Zain Baaity, Roland Fejes, Gabriella Varga, Imre Földesi, Katalin Burián, Andrea Szabó, Mihály Boros, József Kaszaki
Frontiers in Medicine.2022;[Epub] CrossRef - Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study
Nathan J. Smischney, Ashish K. Khanna, Ernesto Brauer, Lee E. Morrow, Uchenna R. Ofoma, David A. Kaufman, Ayan Sen, Chakradhar Venkata, Peter Morris, Vikas Bansal
Journal of Intensive Care Medicine.2021; 36(12): 1466. CrossRef - Inflammatory response, fluid balance and outcome in emergency high‐risk abdominal surgery
Mirjana Cihoric, Henrik Kehlet, Morten L. Lauritsen, Jakob Højlund, Katrine Kanstrup, Nicolai B. Foss
Acta Anaesthesiologica Scandinavica.2021; 65(6): 730. CrossRef - A review on the physiological and pathophysiological role of endothelial glycocalyx
Huan‐qiu Liu, Ji Li, Cheng‐luan Xuan, Hai‐chun Ma
Journal of Biochemical and Molecular Toxicology.2020;[Epub] CrossRef - Science‐in‐brief: The role of the glycocalyx in critically ill patients with reference to the horse
Bettina Dunkel
Equine Veterinary Journal.2020; 52(6): 790. CrossRef
- Augmenting large language models with clinical knowledge graph for personalized perioperative fluid therapy question answering
- Basic Science and Research
- The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores
- Neil J. Glassford, Rinaldo Bellomo
- Korean J Crit Care Med. 2017;32(2):106-123. Published online May 31, 2017
- DOI: https://doi.org/10.4266/kjccm.2017.00192
- 28,013 View
- 395 Download
- 8 Web of Science
- 7 Crossref
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Abstract
PDF
- Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.
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Citations
Citations to this article as recorded by- Impact of CRRT Timing on Mortality in Oliguric Sepsis-Associated Acute Kidney Injury: A Propensity Score Matching Cohort Study
Jing Li, Caiyun Xu, Zhe Huang, Lan Yao, Huayun Liu, Fuxing Deng, Can Zhu, Qinjuan Jiang
Clinical Therapeutics.2026; 48(1): 65. CrossRef - Short-Term Reactions to Oliguria in Critically Ill Patients: A Retrospective Cohort Study
Dekel Stavi, Amir Gal Oz, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Yael Lichter, Ron Wald, Noam Goder
Journal of Clinical Medicine.2025; 14(9): 3107. CrossRef - Comparison of methods to normalize urine output in critically ill patients: a multicenter cohort study
Céline Monard, Nicolas Tebib, Bastien Trächsel, Tatiana Kelevina, Antoine Guillaume Schneider
Critical Care.2024;[Epub] CrossRef - Management of oliguria
Marlies Ostermann, Andrew D. Shaw, Michael Joannidis
Intensive Care Medicine.2023; 49(1): 103. CrossRef - Nomenclature and diagnostic criteria for acute kidney injury – 2020 consensus of the Taiwan AKI-task force
Shao-Yu Yang, Terry Ting-Yu Chiou, Chih-Chung Shiao, Hugo You-Hsien Lin, Ming-Jen Chan, Che-Hsiung Wu, Chiao-Yin Sun, Wei-Jie Wang, Yen-Ta Huang, Vin-Cent Wu, Yung-Chang Chen, Ji-Tsung Fang, Shang-Jyh Hwang, Heng-Chih Pan
Journal of the Formosan Medical Association.2022; 121(4): 749. CrossRef - Haemodynamic frailty – A risk factor for acute kidney injury in the elderly
Neil G. Docherty, Christian Delles, Patrick D’Haese, Anita T. Layton, Carlos Martínez-Salgado, Benjamin A. Vervaet, Francisco J. López-Hernández
Ageing Research Reviews.2021; 70: 101408. CrossRef - Does Fluid Type and Amount Affect Kidney Function in Critical Illness?
Neil J. Glassford, Rinaldo Bellomo
Critical Care Clinics.2018; 34(2): 279. CrossRef
- Impact of CRRT Timing on Mortality in Oliguric Sepsis-Associated Acute Kidney Injury: A Propensity Score Matching Cohort Study
- Cardiology/Surgery/Basic Science and Research
- The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation
- Neil J Glassford, Rinaldo Bellomo
- Korean J Crit Care Med. 2016;31(4):276-299. Published online November 30, 2016
- DOI: https://doi.org/10.4266/kjccm.2016.00934
- 28,204 View
- 627 Download
- 23 Crossref
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Abstract
PDF
- Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.
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Citations
Citations to this article as recorded by- Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study
Barbara Sneyers, Caroline Nyssen, Pierre Bulpa, Isabelle Michaux, Dominique Lacrosse, Philippe E. Dubois, Thomas Rotens, Anne Spinewine
International Journal of Clinical Pharmacy.2025; 47(1): 136. CrossRef - Stewart’s theory and acid–base changes induced by crystalloid infusion in humans: a randomized physiological trial
Antonio Maria Dell’Anna, Domenico Luca Grieco, Cristina Dominedò, Marta Cicetti, Irene Cisterna, Rossano Festa, Rosa Lamacchia, Giuseppina Giannì, Nicoletta Filetici, Teresa Michi, Cristina Rossi, Francesca Danila Alcaro, Alessandro Mele, Aurora Rocchi, D
Annals of Intensive Care.2025; 15(1): 54. CrossRef - Predicting Intravenous Fluid Resuscitation Rate for Burn Patients Through Type-1 Mamdani Fuzzy Inference System Modeling
M. Akhtaruzzaman, Sayma A Suha, Muhammad Nazrul Islam, Md Mahbubur Rahman, Md. Golam Rabiul Alam, Md Abdur Razzak, Mohammad Shahjahan Majib, Quadri Noorulhasan Naveed, Ali M Aseere, Shafat khan
Cureus Journal of Computer Science.2025;[Epub] CrossRef - Uncomplicated Acute Alcohol Intoxication in the Emergency Department: A 12‐Year Retrospective Study to Understand Practice Change in Intravenous Fluid Usage and Patient Outcomes
Jamie Ranse, Amy L. Sweeny, Gerben Keijzers, Stephanie Rae Hagan, Sharon Mickan, Matthew Brendan Munn, Alison Hutton, Michelle Buckland, Laura Hamill, Catherine Delany, Katie East, Julia Crilly
Emergency Medicine Australasia.2025;[Epub] CrossRef - Intravenous fluid mismanagement: time for national stewardship and quality improvement
Andrew Breen, Ashley Miller, Alan Timmins, Greg Barton, Justin Kirk-Bayley, Marcus John Edwards Peck, Huw John Davis, Jonathan Wilkinson
BMJ Open Quality.2025; 14(4): e003503. CrossRef - Uso de fluidoterapia en el periodo perioperatorio en pacientes adultos: revisión narrativa
M.J. Colomina, P. Galán Menéndez, J. Ripollés-Melchor
Revista Española de Anestesiología y Reanimación.2024; 71(10): 748. CrossRef - Use of fluid therapy in perioperative adult patients: A narrative review
M.J. Colomina, P. Galán Menéndez, J. Ripollés-Melchor
Revista Española de Anestesiología y Reanimación (English Edition).2024; 71(10): 748. CrossRef - The Precision Resuscitation With Crystalloids in Sepsis (PRECISE) Trial
Sivasubramanium V. Bhavani, Andre Holder, Danielle Miltz, Rishikesan Kamaleswaran, Sharaf Khan, Kirk Easley, David J. Murphy, Nicole Franks, David W. Wright, Colleen Kraft, Matthew W. Semler, Matthew M. Churpek, Greg S. Martin, Craig M. Coopersmith
JAMA Network Open.2024; 7(9): e2434197. CrossRef - A cost effectiveness analysis of a quality improvement intervention to increase preferential balanced fluid prescribing
Michelle C. Spiegel, Kit N. Simpson, Annie N. Simpson, Andrew J. Goodwin
BMC Health Services Research.2024;[Epub] CrossRef - Closed-Loop Control of Fluid Resuscitation Using Reinforcement Learning
Elham Estiri, Hossein Mirinejad
IEEE Access.2023; 11: 140569. CrossRef - Fluid Stewardship of Maintenance Intravenous Fluids
John R. Carr, W. Anthony Hawkins, Andrea Sikora Newsome, Susan E. Smith, Clemmons Amber B, Christopher M. Bland, Trisha N. Branan
Journal of Pharmacy Practice.2022; 35(5): 769. CrossRef - Clinician attitudes and concordance with self-assessed and actual intravenous fluid prescribing patterns: A single-institution evaluation of survey and electronic prescribing data
Michelle C. Spiegel, Annie N. Simpson, Nandita R. Nadig, Dee W. Ford, Andrew J. Goodwin
The American Journal of the Medical Sciences.2022; 364(1): 36. CrossRef - Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis
Karen Louise Ellekjaer, Anders Perner, Praleene Sivapalan, Morten Hylander Møller
Acta Anaesthesiologica Scandinavica.2022; 66(7): 782. CrossRef - A fuzzy model for predicting burn patients’ intravenous fluid resuscitation rate
Sayma Alam Suha, M. Akhtaruzzaman, Tahsina Farah Sanam
Healthcare Analytics.2022; 2: 100070. CrossRef - Development and implementation of a clinical decision support-based initiative to drive intravenous fluid prescribing
Michelle C. Spiegel, Annie N. Simpson, Achsah Philip, Carolyn M. Bell, Nandita R. Nadig, Dee W. Ford, Andrew J. Goodwin
International Journal of Medical Informatics.2021; 156: 104619. CrossRef - Influence of acetate containing fluid versus lactate containing fluid on acid-base status, electrolyte level, and blood lactate level in dehydrated dogs
Annika Heitland, Ute Klein-Richers, Katrin Hartmann, René Dörfelt
Veterinary World.2021; : 2714. CrossRef - Infusion fluids: a clinical pharmacologist’s view
E.A. Ushkalova, S.K. Zyryanov, K.E. Zatolochina, O.I. Butranova
Anesteziologiya i reanimatologiya.2021; (6): 100. CrossRef - Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist
Brittany D. Bissell, Breanne Mefford
Annals of Pharmacotherapy.2020; 54(4): 388. CrossRef - Lactate versus acetate buffered intravenous crystalloid solutions: a scoping review
Karen L. Ellekjaer, Anders Perner, Martine M. Jensen, Morten H. Møller
British Journal of Anaesthesia.2020; 125(5): 693. CrossRef - Balanced Crystalloid Solutions
Matthew W. Semler, John A. Kellum
American Journal of Respiratory and Critical Care Medicine.2019; 199(8): 952. CrossRef - Does Fluid Type and Amount Affect Kidney Function in Critical Illness?
Neil J. Glassford, Rinaldo Bellomo
Critical Care Clinics.2018; 34(2): 279. CrossRef - Resuscitation fluids
Jonathan D. Casey, Ryan M. Brown, Matthew W. Semler
Current Opinion in Critical Care.2018; 24(6): 512. CrossRef - Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study
Ki Hyun Park, Jung-ho Shin, Jin Ho Hwang, Su Hyun Kim
The Korean Journal of Critical Care Medicine.2017; 32(3): 256. CrossRef
- Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study
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