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Editorials |

Perioperative Fluid Therapy and Postoperative Pulmonary Edema : Cause-Effect Relationship?

Robert R. Kirby, MD, FCCP (Gainesville, FL)
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Professor of Anesthesiology, University of Florida College of Medicine, and Chief, Anesthesiology Service, Veterans Affairs Medical Center.

Correspondence to: Robert R. Kirby, MD, FCCP, Anesthesiology Service, VA Medical Center, 1601 SW Archer Road, Gainesville, FL 32608



Chest. 1999;115(5):1224-1226. doi:10.1378/chest.115.5.1224-a
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Extract

Few topics in operative and perioperative patient management generate more controversy than that of appropriate fluid and electrolyte therapy. From the early studies of Coller et al,1 who advocated, “that no isotonic saline solution or Ringer’s solution should be given during the day of operation and during the subsequent first two postoperative days”; through those of Shires and associates,23 who demonstrated significant functional extracellular fluid volume deficits associated with major surgical procedures and hemorrhagic shock, and advocated correction of these deficits by the administration of substantial volumes of balanced electrolyte containing solutions such as Ringer’s lactate; to the modern era, in which primary controversy has swirled around colloid vs crystalloid therapy and the composition of administered fluids, agreement among clinicians as to what fluid therapy is appropriate, and in what amount, is rare. This controversy likely will be enhanced by Arieff’s provocative article in this issue of CHEST (see page 1371). He describes 11 adult and two pediatric patients. Nine patients were treated in two university hospitals, and four were treated in affiliated community hospitals. All developed fatal postoperative pulmonary edema, seemingly caused solely by excessive postoperative fluid administration. In eight of these cases, the heralding sign of pulmonary edema was cardiorespiratory arrest.


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