Rational fluid management: Dissecting facts from fiction

摘要

In the Sceptic's Medical Dictionary,1 an iconoclastic book we highly recommend, Michael O'Donnell defines clinical experience as 'Making the same mistakes with increasing confidence over an impressive number of years'. Although provocative, this statement is sometimes not so far from reality when considering intra- and postoperative fluid management. For decades, the decision to give fluid was based on clinical examination, heart rate, and arterial pressure, for example, a high heart rate and low arterial pressure often triggering a fluid bolus, when not simply based on the gut feeling of the good doctor. Unfortunately, tachycardia and hypotension are not specific and sensitive markers of hypovolaemia. Many studies have also demonstrated the limited value of cardiac filling pressures to predict fluid responsiveness.