Book contents
- Frontmatter
- Contents
- Foreword
- Contributors
- 1 Introducing evidence-based anaesthesia
- 2 How to define the questions
- 3 Developing a search strategy, locating studies and electronic databases
- 4 Retrieving the data
- 5 Critical appraisal and presentation of study details
- 6 Outcomes
- 7 The meta-analysis of a systematic review
- 8 Bias in systematic reviews: considerations when updating your knowledge
- 9 The Cochrane Collaboration and the Cochrane Anaesthesia Review Group
- 10 Integrating clinical practice and evidence: how to learn and teach evidence-based medicine
- 11 Involving patients and consumers in health care and decision-making processes: nothing about us without us
- 12 Evidence-based medicine in the Third World
- 13 Preoperative anaesthesia evaluation
- 14 Regional anaesthesia versus general anaesthesia
- 15 Fluid therapy
- 16 Antiemetics
- 17 Anaesthesia for day-case surgery
- 18 Obstetrical anaesthesia
- 19 Anaesthesia for major abdominal and urological surgery
- 20 Anaesthesia for paediatric surgery
- 21 Anaesthesia for eye, ENT and dental surgery
- 22 Anaesthesia for neurosurgery
- 23 Cardiothoracic anaesthesia and critical care
- 24 Postoperative pain therapy
- 25 Critical care medicine
- 26 Emergency medicine: cardiac arrest management, severe burns, near-drowning and multiple trauma
- Glossary of terms
- Index
15 - Fluid therapy
Published online by Cambridge University Press: 05 September 2009
- Frontmatter
- Contents
- Foreword
- Contributors
- 1 Introducing evidence-based anaesthesia
- 2 How to define the questions
- 3 Developing a search strategy, locating studies and electronic databases
- 4 Retrieving the data
- 5 Critical appraisal and presentation of study details
- 6 Outcomes
- 7 The meta-analysis of a systematic review
- 8 Bias in systematic reviews: considerations when updating your knowledge
- 9 The Cochrane Collaboration and the Cochrane Anaesthesia Review Group
- 10 Integrating clinical practice and evidence: how to learn and teach evidence-based medicine
- 11 Involving patients and consumers in health care and decision-making processes: nothing about us without us
- 12 Evidence-based medicine in the Third World
- 13 Preoperative anaesthesia evaluation
- 14 Regional anaesthesia versus general anaesthesia
- 15 Fluid therapy
- 16 Antiemetics
- 17 Anaesthesia for day-case surgery
- 18 Obstetrical anaesthesia
- 19 Anaesthesia for major abdominal and urological surgery
- 20 Anaesthesia for paediatric surgery
- 21 Anaesthesia for eye, ENT and dental surgery
- 22 Anaesthesia for neurosurgery
- 23 Cardiothoracic anaesthesia and critical care
- 24 Postoperative pain therapy
- 25 Critical care medicine
- 26 Emergency medicine: cardiac arrest management, severe burns, near-drowning and multiple trauma
- Glossary of terms
- Index
Summary
Despite hundreds of laboratory and clinical studies, the choice of intravenous (IV) fluid, the volume of fluid to be administered, and the timing of fluid administration remain controversial. Based on the evidence from clinical trials and meta-analyses, a statistically significant reduction in mortality or relevant adverse clinical outcomes amongst surgical or critically ill adult or paediatric patients has not been found with the use of any particular IV fluid.
Restrictive fluid regimens may decrease perioperative morbidity in adults undergoing elective intra-abdominal surgery but the results cannot be generalised to other populations or procedures. The effect of restricted versus liberal fluid regimens on clinical outcomes in patients undergoing minimally invasive or ambulatory procedures is still inconclusive.
Although there is a trend in fewer deaths with delayed fluid resuscitation of patients with penetrating trauma, the data are insufficient to draw guidelines. Large multicentre randomised controlled trials (RCTs) of fluid regimens with clinically relevant outcomes are still needed to address important questions in this field.
Introduction
The use of IV fluids for volume resuscitation and fluid replacement in the surgical or critically ill patient has been studied and practiced for nearly 90 years. Despite hundreds of laboratory and clinical studies, the choice of IV fluid, the volume of fluid to be administered, and the timing of fluid administration remain controversial.
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- Evidence-based Anaesthesia and Intensive Care , pp. 151 - 168Publisher: Cambridge University PressPrint publication year: 2006