PERIOPERATIVE FLUID MANAGEMENT.

Foreword
Preface for the Second Edition
Contents
Part I: Fundamentals of Fluid Management
	1: A History of Fluid Management
		Earliest Times
			Bloodletting
		Beginnings of Intravenous Therapy
			Intravenous Infusions of Drugs and Fluids: Mainly in Dogs
			Early Attempts with Needles and Syringes
			The Cholera Epidemic
			Improving the Infused Solution
		Needles and Syringes
		Infusion Rates
		Conclusion
		References
	2: The Revised Starling Principle and Its Relevance to Perioperative Fluid Management
		Introduction
		Starling’s Hypothesis and Its Traditional Interpretation
		Microvascular Pressures, Vascular Resistance, and Fluid Exchange in Organs and Tissues
		The Osmotic Reflection Coefficient
		The Hydrostatic and Colloid Osmotic Pressures of the Interstitial Fluids
		Steady State Fluid Exchange Between the Plasma and the Tissues
		Steady State Fluid Uptake in Specialized Tissues
		Which Effective Colloid Osmotic Difference Is Relevant to Fluid Exchange?
		A Picture to Forget
		Relevance of the Revised Starling Principle to Intravenous Fluid Therapy
		A Note on the Measurements of Changes in Plasma Volume
		Conclusion
		Appendix
		References
	3: The Functions of Endothelial Glycocalyx and Their Effects on Patient Outcomes During the Perioperative Period: A Review of Current Methods to Evaluate Structure-Function Relations in the Glycocalyx in Both Basic Research and Clinical Settings
		Introduction
		Composition in Relation to a Layered Structure
		Restoration and Preservation of the Glycocalyx
		Imaging the Glycocalyx and Structure-Function Relationships
		The Glycocalyx as a 3 Dimensional Layered Structure in Microvessels
		Quantitative Investigations of Glycocalyx Structure-Function
		Measurement of Red Cell Gap in Human Subjects
		Glycocalyx Volume Measurement in Human Subjects
		The Glycocalyx in Large Vessels
		Background: Imaging the Glycocalyx: More Detailed Technical Issues
			Light vs Electron Microscopy
			Tissue Preparation
			Advances in Staining Technology
			Future Directions in Glycocalyx Imaging
		Summary. Frequently Asked Questions and some Answers Based on Sections “Introduction” to “Background: Imaging the Glycocalyx: More Detailed Technical Issues”
		References
	4: Techniques for Goal-Directed Fluid Management
		Introduction
		The Concept of Fluid Responsiveness
		Methods to Assess Fluid Responsiveness
			Static Pressure and Volume Variables for Assessing Fluid Responsiveness
			“Dynamic” Methods to Assess Fluid Responsiveness
		The Passive Leg Raising Maneuver and the Fluid Challenge
		Goal-Directed Fluid Management and the Fluid Bolus Approach
		Conclusion
		References
	5: Dynamic Arterial Elastance: Physiology, Data and Implementation
		Introduction
		Arterial Waveforms and the Arterial Tree
		Data and Utility
		Conclusion
		References
	6: The Perioperative Use of Echocardiography for Fluid Management
		Introduction
		Indications for Echocardiography in Assessment of Volume Status
			Two-Dimensional Echocardiographic Assessment of Left Ventricle Chamber Dimensions
			Two-Dimensional Echocardiography for Assessment of Ventricle End-Diastolic and End Systolic Areas
			Two-Dimensional Echocardiography for Assessment of Left Ventricle Volume
			Three-Dimensional Echocardiography for Assessment of Left Ventricle Volume
		Inferior Vena Cava Size and Collapsibility
			Transthoracic Echocardiography in the Spontaneously Breathing Patient
			Transesophageal Echocardiography in the Mechanically Ventilated Patient
		Superior Vena Cava Size and Collapsibility
			Transesophageal Echoacardiography in the Mechanically Ventilated Patient
		Respiratory Variations in Left Ventricle Stroke Volume
		Passive Leg Raising Test for the Prediction of Volume Responsiveness in the Spontaneously Breathing Patient (Combined with Changes in Stroke Volume)
		Conclusion
		References
	7: Microcirculatory Blood Flow as a New Tool for Perioperative Fluid Management
		Introduction
		Characterization of the Microvascular Alterations Observed in the Perioperative Setting
		The Risks of Fluid Administration for Microvascular Perfusion
		Impact of Fluids on Microvascular Perfusion: What is the Evidence?
		Colloids Versus Crytalloids
		Red Blood Cell Transfusions?
		How Can We Assess the Microcirculation at Bedside?
		Conclusions
		References
	8: Mean Systemic Filling Pressure Is an Old Concept but a New Tool for Fluid Management
		Introduction
		The Venous System
			Arterial Baroreceptor Reflex Influence
			Chemoreceptor Reflex Influence
			The Capacitance Vessels
		The Mean Systemic Filling Pressure
		Measurement of the PMSF in Humans with Intact Circulation
		Should the Venous Tone be Monitored at Bedside? Practical Implications
		Conclusion
		References
	9: Restricted or Liberal Fluid Therapy
		Introduction
		The Michel–Weinbaum Model
		The Revised Starling Equation and Glycocalyx Model (RSE&GM) Paradigm
		Heterogeneity of the Microvasculature
		Hahn’s Volume Kinetics
		Three Intravascular Fluid Volumes
		Biophysical Osmotherapy Causes Haemodilution
		The J-Curve and the J-Point
		Manipulating Capillary Pressure
		Understanding “Leaky Capillaries”
		The Circulation of Tissue Fluid to Lymphatic Vessels and Return to the Intravascular Space
		Missing Sodium
		Intracellular Fluid Volume Is Regulated Independently of Total Body Water
		A Revised Twigley–Hillman Diagram
		Exceptions to the No Steady State Absorption Rule: Hypodermoclysis
		Exceptions to the ‘No Steady-State Absorption’ Rule: Effect of Local Epithelial Transport
		Exceptions to the ‘No Steady-State Absorption’ Rule: Discontinuous Capillaries of the Sinusoidal Tissues
		Scientific Method in Peri-operative Fluid Therapy Research
		Clinical Research
		Special Case Surgery?
		Safely Implementing a Smaller Volume Approach to Perioperative Fluid Therapy
			Fluid Balance Monitoring
			Infuse Colloids?
			Oliguria
			Thirst
			Reduce Venous Capacitance
			Sodium Dose
			Protect Lymphatic Pump Efficiency
		Monitoring for Euvolemic Goal-directed Therapy
		Monitoring for Hypervolemic/Hyperdynamic Goal-directed Fluid Therapy
			Avoid Fluid Boluses
		References
	10: The Perioperative Use of Albumin
		Introduction
		Albumin Gene and Structure
		Albumin and Its Role in Endothelial Barrier
		Albumin as a Major Antioxidant
		Anticoagulant Effect
		Enzymatic Properties of HSA
		Hypoalbuminemia
		Human Serum Albumin Metabolism
		The Use of Albumin in Perioperative Settings
			The Use of Albumin in Sepsis
			Albumin as a Neuroprotective Agent in Animal Experiments and Clinical Settings
			Albumin Use in Patients with Traumatic Brain Injury
			Albumin and Cardiac Surgery
		Albumin Solutions
		Conclusion
		References
	11: Albumin in the Critically Ill
		Introduction
		Critical Illness Pathophysiology and Resuscitation
		Commercial Preparations of Albumin
		Albumin Advantages and Disadvantages: Where Is This Evidence?
		Albumin in Critical Care
		Albumin in Hypoalbuminemic States
		Albumin in Burns
		Albumin After Neurological Insult
		Albumin in the Cardiovascular ICU
		Efficacy and Safety of 20% Albumin as Compared to 5% Albumin
		Limitations of Use of Albumin
		Conclusion
		References
	12: The Dilemma for Using Hydroxyethyl Starch Solutions for Perioperative Fluid Management
		Introduction
			Current Situation
		Approval of Hydroxyethyl Starch in 1971
		Dose Limits
		Pharmacokinetic Properties of Hydroxyethyl Starch
		The Metabolic Fate of the Hydroxyethyl Starch Molecule
		Transvascular Fluid Exchange and the Updated Starling Model
		Hemodynamic Effects
		Do Patients Benefit from Hydroxyethyl Starch?
		Hydroxyethyl Starch Toxicity
		Mortality
		Coagulopathy and Prolonged Bleeding
		Kidney Failure in Critically Ill and Mixed Populations
		Kidney Failure in Surgical or Trauma Patients
		Liver Dysfunction and Hydroxyethyl Starch Storage Disease
		Quality of Life After Sepsis
		Pediatric Patients
		The Dilemma
		Conclusion
		References
	13: Balanced Versus Unbalanced Salt Solutions in the Perioperative Period
		What Is a Balanced Salt Solution?
		Importance of Atomic Elements in Bodily Solutions: An Evolutionary Story
		Why Is the Concentration of Cl− Less Than the Concentration of Na+?
		Strong Ions and the Concentration of Hydrogen Ion (H+)
		Balance in the Body
		How Is the Difference Between Na+ and Cl− in Blood Regulated?
		Physiological Studies of Cl− and Renal Function
		Balanced Salt and Gut Function
		What Substance Can Be Used to “Balance” Na+ in Intravenous Solutions?
			Acetate
			Gluconate
			Other Anions
		Clinical Outcome Studies
		Observational Studies
		Randomized Trials
			SPLIT Study
			SALT Studies
			PLUS
		Design of Studies
		Clinical Considerations in the Peri-operative Period
		Conclusion
		References
	14: Positive Fluid Balance and Patients’ Outcomes
		Introduction
		Fluid Balance and Outcomes: Summary of Clinical Studies
		Why Is Fluid Given and Where Does It Go?: The Body Fluid Compartments
		The Body Fluid Compartments
		Internal Sensing of Fluid Balance
		Why Positive Fluid Balance Might Be Harmful
		The Fate of Administered Fate: Risk Factors for Fluid Retention
		How Quickly to Safely Diurese: The Capillary Fluid Refill Rate
		Clinical Correlation
		Conclusion
		References
	15: Fluid Management and Its Role in Enhanced Recovery
		Introduction
		The Benefits of Enhanced Recovery Pathways
		Components of Enhanced Recovery Pathways
		Fluid Therapy in Enhanced Recovery: The Optimal Approach
		Preoperative Fluid Management
		Intraoperative Fluid Management
		Postoperative Fluid Management
		The Need to Individualize Fluid Therapy
		Clinical Assessment of Fluid Status
		Using Dynamic Variables to Assess Fluid Status
		Goal-Directed Fluid Therapy
		Goal-Directed Fluid Therapy in Enhanced Recovery Protocols
		Fluid Choice
		Conclusion
		References
	16: Venous Circulation: A Few Challenging Concepts in Goal-Directed Hemodynamic Therapy (GDHT)
		Background and Basic Concepts
		Definitions and their Physiologic Meanings
		Determinants of Cardiac Output
		Physiologic Basis for GDHT and Fluid Responsiveness
		The Physiologic Effects of some Adrenergic Drugs on the Venous System
		Conclusions and Clinical Implications
		References
	17: Perioperative Fluid Management in Pediatric Patients
		Introduction
		Body Fluid Compartments
		Circulating Blood Volume
		Preoperative Fasting
		Volume Assessment and Estimation of Fluid Deficit
		Fluid and Electrolytes Requirements
		Types of Intravenous Fluids (IVF)
			Crystalloid Solutions
			Colloids Solutions
		Importance of Maintaining Euglycemia during Perioperative Period
		Intraoperative Fluid Management
		Intraoperative Fluid Therapy in Neonates
		Postoperative Fluid Management and Hyponatremia
		Clinical Situations Requiring Special Consideration
		Conclusion
		References
	18: Restricted Versus Liberal Fluid Management Pros and Cons
		Introduction
		State of the Evidence
			Fluid Management and Postoperative Gastrointestinal Recovery
			Fluid Management and Surgical Site Infections
			Acute Kidney Injury
			Overall Complications and LOS
		Normovolemia or Balanced Fluid Administration
		Summary and Considerations for Current Practice
		References
	19: Artificial Intelligence for Perioperative Fluid Management
		Introduction to Artificial Intelligence
		Fluid Status Measurements Using AI
		Applications of Predictive Analytics and Arterial Waveform Analysis
		Quality and Performance Analysis of Fluid Management Using Machine Learning
		Sepsis-fluid Management Using AI for Critically Ill
		Future Directions
		References
Part II: Case Scenarios Management During Colorectal, Orthopedic, and Spine Cases
	20: Case Scenario for Perioperative Fluid Management in Major Orthopedic Surgery
		Introduction
		Case History
			Preoperative Management
			Intraoperative Management
		Monitoring
		Maintenance
		Fluid and Hemodynamic Management
			Postoperative Management
		Discussion
		Conclusion
		References
	21: Case Scenario for Perioperative Fluid Management for Major Colorectal Surgery
		Introduction
		Enhanced Recovery After Surgery
		Fluid Management
			Goal-Directed Therapy
		Advanced Hemodynamic Monitoring.
		Evidence for GDT
		Case History
			Preoperative Management
			Intraoperative Management
		Monitoring
		Maintenance
		Fluid and Hemodynamic Management
			Postoperative Management
		Discussion
		Conclusion
		References
	22: Case Scenario for Fluid Therapy in Septic Shock
		Case Scenario
		Discussion
		References
	23: Case Scenario for Fluid Management in Liver Resection
		Case Scenario
		Discussion
			Use of Thromboelastography
		Choice of Fluids
		Fluid Management Strategies during Liver Resection
		Surgical Techniques to Limit Blood Loss during Hepatic Surgery
		References
	24: Case Scenario for Fluid Management during Major Spine Surgery
		Introduction
		Case History: The Typical Patient
		Discussion
			Hypertension, Hypotension, and Spine Surgery
			Fluid Management
		Monitoring the Patient in the Prone Position
		Blood Conservation
		Blood Conservation Therapies
			Enhanced Hematopoesis
		Intraoperative Hypotension, Anemia, and Cardiac Ischemia
			Case Scenario (Continued)
			Case Scenario (Continued)
			Case Scenario (Continued)
		The Surgery
			Case Scenario (Continued)
			Vascular Injury
		Fluid Management and Postoperative Vision Loss
			Case Scenario (Continued)
			Prone Positioning
		Intraoperative Neurophysiologic Monitoring
			Spinal Surgery Complications
			Case Scenario (Continued)
		Anesthesia Concerns
			Anesthesia
			Case Scenario (Continued)
		Pulmonary Complications
			Case Scenario (Continued)
		Postoperative Analgesia
			Case Scenario (Continued)
			Postoperative Recovery
		Conclusion
		References
	25: Case Scenario for Fluid Management After Subarachnoid Hemorrhage in the Neuro-Intensive Care Unit
		Introduction
		Case Scenario
		Discussion
			Diagnosis and Treatment Effect Monitoring
		Conclusion
		References
	26: Case Scenario for Fluid Management in Cardio-Thoracic Surgery
		Discussion
			Transfusion Triggers
			Define the Hemodynamic Goals
			When Is i.v. Volume Expansion Indicated?
			Central Venous Pressure Is Not a Good Indicator of Hypovolemia
				Dynamic Indices of Fluid Responsiveness: Pulse Pressure Variation (PPV)
				Validity of PPV in Cardiac and Thoracic Surgery
				Systolic Pressure Variation
				Esophageal Doppler
				Plethysmographic Variation (PVI)
				Echocardiographic Indices
			Should i.v. Fluids Administered if Patients Are Found to Be Fluid Responsive?
			What Is the Preferred Intravascular Volume Expander?
		References
	27: Case Scenario of Fluid Management for Thoracic Surgery
		Introduction
		Discussion
		Pathogenesis of ALI
		A Multi-hit Hypothesis for ALI [38]
		Intraoperative Fluid Management Strategy During Thoracic Surgery
		Nature of the Fluid to Use Perioperatively; Colloids or Crystalloids
		Restrictive and Goal-Directed Fluid Therapy
			Restrictive Fluid Management
			Goal-Directed Fluid Therapy in Thoracic Surgery
		References
	28: Fluid Management During Major Vascular Surgery
		Introduction
		Case
		Preoperative Evaluation
		Anesthetic Plan
		Monitoring
		Aortic Cross-Clamping
		Renal Protection
		Unclamping the Aorta
		Fluid Management
		Postoperative Course
		Conclusion
		References
	29: Case Scenario for Fluid Management in Obstetrics
		Perioperative Fluid Management
		Fluid Homeostasis During Pregnancy
		Clinical Case Scenario
		General Preparation for Caesarean Section
		Requirement for Monitoring
		Intraoperative Anesthetic Management
		Combined Spinal-Epidural (CSE)
		Discussion and Rational
		Fluid Management in Normal Labor
		Fluid Management in Caesarean Section
		Hemodynamic Monitoring in Obstetric Critical Care
		Back to Case Scenario
		Fetal Consideration
		Conclusion
		References
Index