Grass et al present a timely and welcome study on fluid management as an important
element in enhanced recovery after surgery (ERAS) protocols. I agree with the authors
that restrictive fluid management of ERAS has not been adequately assessed.
1
A so-called “goal-directed” fluid management strategy is recommended with a cutoff
of “3 L (liters),” but the goal is not clearly defined other than to “avoid adverse
outcomes.”
1
However, unintended consequences have been associated with stringent fluid management,
namely acute kidney injury (AKI), with the “odds of developing AKI more than doubled
compared to…before ERAS implementation.”
2
Proposing arbitrary fluid limits ignores important patient variables such as age,
body mass index, baseline renal function–serum creatinine (SCr), and length of operation.To read this article in full you will need to make a payment
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References
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- Diuretics and the perioperative fluid balance.Dis Colon Rectum. 2018; 61: 1125-1127
- Early diuresis after colon and rectal surgery does not reduce length of hospital stay: results of a randomized trial.Dis Colon Rectum. 2018; 61: 1187-1195
- Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery.BJS Open. 2019; 3: 532-538
- American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery.Perioper Med (Lond). 2016; 5: 24
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Article info
Publication history
Published online: June 03, 2020
Accepted:
April 7,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
