Towards a new standard of perioperative fluid management.

Recent studies suggest that current fluid strategies may result in excessive administration of both fluids and electrolytes. Perioperative fluid administration is dictated by an algorithmic approach, taking account of pre-operative deficit, maintenance requirements, and extrapolated third space losses. Salt and water overload is associated with pulmonary edema, ileus, and delayed wound healing. Within an intensive care population, there is a strong correlation between excessive intravascular volume and subsequent mortality, morbidity, and length of stay. Increasing weight has been shown to correspond with mortality, while achieving a negative balance within the first 72 hours of ITU admission has been postulated as an independent predictor of survival. Should a "restricted" rather than a "liberal" perioperative fluid regimen be employed? It is arguable that prevailing fluid therapy is not evidence-based. Recent observations suggest that restraint in fluid administration correlates with better outcome. The development of a protocol-based fluid optimization program may help minimize the risk of perioperative fluid overload.