The Australian approach to peri-operative fluid balance

Purpose of review The role of fluid balance as an important contributor to patient morbidity and mortality in the peri-operative period is only now being understood. Numerous studies in disparate populations undergoing different surgeries suggest that. Recent findings There is wide disparity in fluid administration regimen between speciality, country, and clinician. Recent meta-analyses of published studies have shown that restrictive fluid administration strategies may improve patient-centred outcomes when compared to liberal regimens. Current evidence suggests a significant role for fluid accumulation in the development of peri-operative complications. Fluid balance is best achieved using goal-directed techniques. The evidence base is, at present, sub-optimal, with a paucity of level 1 evidence for clinical decision-making. Summary In the absence of level 1evidence it is difficult to make firm recommendations about practice, though observational and single-centre data suggest a significant survival advantage may be conferred by the perioperative administration of fluids to monitored physiological targets only. The Australian approach to perioperative fluid management is to create level 1 evidence. To this end, the development of a large multicentre randomized controlled trial of peri-operative fluid administration is underway.