Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Minerva Anestesiologica 2017 June;83(6) > Minerva Anestesiologica 2017 June;83(6):638-51

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Publication history
Estratti
Per citare questo articolo

MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,623


eTOC

 

REVIEW  FREEfree


Minerva Anestesiologica 2017 June;83(6):638-51

DOI: 10.23736/S0375-9393.17.11512-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Fluid management in cardiac surgery patients: pitfalls, challenges and solutions

Elena BIGNAMI , Marcello GUARNIERI, Marco GEMMA

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy


FULL TEXT  


Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality. Many small randomized clinical trials focusing on coagulation and bleeding show controversial results regarding fluid safety during the perioperative period in cardiac surgery, and in the cardiac ICU. No definitive data are available on the superiority of one fluid compared with another for fluid replacement after cardiac surgery. Only few data are available regarding the impact of fluids on kidney function in the cardiac ICU. On the other hand, there is much evidence showing that fluid administration requires strict protocols and close monitoring. Improved clinical outcomes are evident in protocols for goal-directed therapy. In conclusion, the application of a close monitoring and a pre-defined goal-directed protocol are far more important than the choice of a single fluid. This review examines the available evidence on fluid management in cardiac surgery and in the ICU, and analyzes the key steps of fluid strategy in these settings.


KEY WORDS: Body fluids - Cardiac surgical procedures - Acute kidney injury - Blood coagulation - Intensive care units

inizio pagina

Publication History

Issue published online: June 7, 2017
Article first published online: January 17, 2017
Manuscript accepted: January 9, 2017
Manuscript revised: January 4, 2017
Manuscript received: June 27, 2016

Per citare questo articolo

Bignami E, Guarnieri M, Gemma M. Fluid management in cardiac surgery patients: pitfalls, challenges and solutions. Minerva Anestesiol 2017;83:638-51. DOI: 10.23736/S0375-9393.17.11512-9

Corresponding author e-mail

bignami.elena@hsr.it