13 de setembro de 2011

Artigo recomendado: Fluid Therapy and Surgical Outcomes in Elective Surgery: A Need for Reassessment in Fast-Track Surgery


Kathrine Holte, MD, Henrik Kehlet, MD, PhD, FACS(HON)

J Am Coll Surg Vol. 202, No. 6, June 2006

Principles in perioperative fluid management and their implications for outcomes in elective surgery are controversial because there are limited data from randomized studies.1,2 Although numerous previous studies and several systematic reviews have compared different types of fluids for resuscitation, the results so far have been inconclusive.3-8 Importantly, the vast majority of studies included in these reviews focused on critically ill patients, with conclusions not necessarily applicable for patients undergoing elective surgical procedures.

Recent data suggest that not only the type of fluid, but also the amount of fluid administered perioperatively may influence surgical outcomes,1,2,9-12 a factor not often recognized in previous studies on perioperative fluid management. Recent data have demonstrated that amultimodal revision of principles for postoperative caremay improve outcomes after major surgical procedures (eg, fast-track surgery),13-15 findings that might also have implications for fluid management practices.

We conducted a systematic review of randomized, controlled trials with a focus on the influence of the types of fluid (eg, crystalloids, colloids, and hypertonic solutions) and the amounts of fluid administered perioperatively for fluid resuscitation purposes on surgical outcomes in elective noncardiac surgical procedures. The aim of this review was to examine the evidence from randomized trials concerning the effects of perioperative fluid administration (type and amounts) on surgical outcomes in elective surgical procedures.

These results are discussed within the concept of fast-track surgery, with proposals for improved design of future studies of perioperative fluid management to determine its role in postoperative recovery.

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