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Determinanten des insensiblen Flüssigkeitsverlustes

Perspiratio, Proteinshift und endotheliale Glykokalyx

Determinants of insensible fluid loss

Perspiration, protein shift and endothelial glycocalyx

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Ein Mythos, der dem Logos nicht standhält, zerbricht an der Wahrheit (Papst Benedikt XVI.)

Zusammenfassung

Die korrekte perioperative Flüssigkeitsbilanz ist Grundlage einer zielgerichteten Infusionspraxis. Weder Ausgangsstatus noch perioperative Veränderungen der Flüssigkeitsräume lassen sich jedoch in der täglichen Routine verlässlich bestimmen. Insbesondere die insensiblen Verluste werden nach wie vor nicht einheitlich beurteilt, und deren Substitution erfolgt daher zum großen Teil empirisch. Die vorliegende Arbeit soll die wissenschaftliche Datenlage zu diesem Thema vermitteln.

Präoperative Nüchternheit (10 h) erzeugt per se keine relevante Hypovolämie. Die Gesamtevaporation über Haut, Atemwege und Wundfläche während großer abdominaler Eingriffe beträgt beim Erwachsenen weniger als 1 ml/kg/h. Ein perioperativ inkonstant auftretender Flüssigkeits- und Proteinshift in das Interstitium scheint hypervolämieassoziiert und somit vermeidbar zu sein. Die entscheidende Rolle spielt hierbei die Zerstörung der endothelialen Glykokalyx, deren weitere pathophysiologische Bedeutung bislang nur ansatzweise bekannt ist. Klinische Studien konnten den Zusammenhang zwischen Flüssigkeitsrestriktion und verbessertem Outcome nach großen abdominalen Eingriffen demonstrieren.

Abstract

Accurate perioperative fluid balance is the basis of a targeted infusion regimen. However, neither the initial status nor perioperative changes of the fluid compartments can be reliably measured in daily routine. In particular, insensible losses are not consistently assessed, so that substitution therapy is generally empirical. The object of this paper is to communicate the scientific data on this topic.

Preoperative fasting (10 h) does not per se cause intravascular hypovolemia. In adults, total basal evaporation by way of the skin and airways and of any wounds during major abdominal interventions is usually less than 1 ml/kg/h. An inconstant fluid and protein shift towards the interstitial space perioperatively seems to be associated with hypervolemia, which suggests it should be preventable. The decisive factor in this context seems to be deterioration of the endothelial glycocalyx, whose further patho-physiological impact is currently only partially known. Clinical studies have revealed a link between fluid restriction and improved outcome after major abdominal surgery.

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Literatur

  1. Adamson RH, Clough G (1992) Plasma proteins modify the endothelial cell glycocalyx of frog mesenteric microvessels. J Physiol 445: 473–486

    PubMed  CAS  Google Scholar 

  2. Adamson RH, Lenz JF, Zhang X et al. (2004) Oncotic pressures opposing filtration across non-fenestrated rat microvessels. J Physiol 557: 889–907

    Article  PubMed  CAS  Google Scholar 

  3. Andersen LJ, Jensen TU, Bestle MH, Bie P (1999) Isotonic and hypertonic sodium loading in supine humans. Acta Physiol Scand 166: 23–30

    Article  PubMed  CAS  Google Scholar 

  4. Andersen LJ, Norsk P, Johansen LB et al. (1998) Osmoregulatory control of renal sodium excretion after sodium loading in humans. Am J Physiol 275: R1833–R1842

    PubMed  CAS  Google Scholar 

  5. Arkilic CF, Taguchi A, Sharma N et al. (2003) Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 133: 49–55

    Article  PubMed  Google Scholar 

  6. Badoe EA (1968) Pulmonary and cutaneous fluid losses in the Ghanaian in Korle Bu Hospital, Accra. West Afr Med J Niger Pract 17: 236–237

    PubMed  CAS  Google Scholar 

  7. Barnadas MA, Cistero A, Sitjas D et al. (1995) Systemic capillary leak syndrome. J Am Acad Dermatol 32: 364–366

    Article  PubMed  CAS  Google Scholar 

  8. Baumber CD, Clark RG (1974) Insensible water loss in surgical patients. Br J Surg 61: 53–56

    Article  PubMed  CAS  Google Scholar 

  9. Baumber CD, Clark RG, Howlett P (1972) Insensible water loss in operative patients. Br J Surg 59: 300

    PubMed  CAS  Google Scholar 

  10. Belin CE de, Gauquelin-Koch G, Duvareille M et al. (2006) Blood volume measurement: The comparison of pulse dye densitometry and Dill and Costill’s methods. Life Sci 78: 1564–1569

    Article  CAS  Google Scholar 

  11. Bellomo R (2002) Fluid resuscitation: Colloids vs. crystalloids. Blood Purif 20: 239–242

    Article  PubMed  CAS  Google Scholar 

  12. Benedict FG (1933) Die Messung des unmerklichen Gewichtsverlusts beim Menschen in Laboratorium und Klinik. Z Gesamte Exp Med 91: 340

    Article  CAS  Google Scholar 

  13. Boldt J (2000) The good, the bad, and the ugly: Should we completely banish human albumin from our intensive care units? Anesth Analg 91: 887–895

    Article  PubMed  CAS  Google Scholar 

  14. Boldt J, Ducke M, Kumle B et al. (2004) Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery. Intensive Care Med 30: 416–422

    Article  PubMed  Google Scholar 

  15. Boldt J, Haisch G, Suttner S et al. (2002) Are lactated Ringer’s solution and normal saline solution equal with regard to coagulation? Anesth Analg 94: 378–384

    Article  PubMed  CAS  Google Scholar 

  16. Bone RC (1991) The pathogenesis of sepsis. Ann Intern Med 115: 457–469

    PubMed  CAS  Google Scholar 

  17. Brandstrup B, Tonnesen H, Beier-Holgersen R et al. (2003) Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial. Ann Surg 238: 641–648

    Article  PubMed  Google Scholar 

  18. Bruegger D, Jacob M, Rehm M et al. (2005) Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts. Am J Physiol Heart Circ Physiol 289: H1993–H1999

    Article  PubMed  CAS  Google Scholar 

  19. Campbell IT, Baxter JN, Tweedie IE et al. (1990) IV fluids during surgery. Br J Anaesth 65: 726–729

    Article  PubMed  CAS  Google Scholar 

  20. Carrico CJ, Canizaro PC, Shires GT (1976) Fluid resuscitation following injury: Rationale for the use of balanced salt solutions. Crit Care Med 4: 46–54

    Article  PubMed  CAS  Google Scholar 

  21. Chan ST, Kapadia CR, Johnson AW et al. (1983) Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses. Br J Surg 70: 36–39

    Article  PubMed  CAS  Google Scholar 

  22. Chan WS, Irwin MG, Tong WN, Lam YH (1997) Prevention of hypotension during spinal anaesthesia for caesarean section: Ephedrine infusion versus fluid preload. Anaesthesia 52: 908–913

    Article  PubMed  CAS  Google Scholar 

  23. Choi PT, Yip G, Quinonez LG, Cook DJ (1999) Crystalloids vs. colloids in fluid resuscitation: A systematic review. Crit Care Med 27: 200–210

    Article  PubMed  CAS  Google Scholar 

  24. Christopherson R, Beattie C, Frank SM et al. (1993) Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 79: 422–434

    Article  PubMed  CAS  Google Scholar 

  25. Cleland J, Pluth JR, Tauxe WN, Kirklin JW (1966) Blood volume and body fluid compartment changes soon after closed and open intracardiac surgery. J Thorac Cardiovasc Surg 52: 698–705

    PubMed  CAS  Google Scholar 

  26. Coe AJ, Revanas B (1990) Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia 45: 241–243

    Article  PubMed  CAS  Google Scholar 

  27. Coller FA, Maddock WG (1932) Dehydration attendant on surgical operation. JAMA 875

  28. Collins JV, Cochrane GM, Davis J et al. (1973) Some aspects of pulmonary function after rapid saline infusion in healthy subjects. Clin Sci Mol Med 45: 407–410

    PubMed  CAS  Google Scholar 

  29. Dawidson IJ, Willms CD, Sandor ZF et al. (1991) Ringer’s lactate with or without 3% dextran-60 as volume expanders during abdominal aortic surgery. Crit Care Med 19: 36–42

    Article  PubMed  CAS  Google Scholar 

  30. Dawson JL (1968) Acute post-operative renal failure in obstructive jaundice. Ann R Coll Surg Engl 42: 163–181

    PubMed  CAS  Google Scholar 

  31. De GA, Narcisi S, Mazza E et al. (2006) Perioperative fluid management in kidney transplantation: Is volume overload still mandatory for graft function? Transplant Proc 38: 807–809

    Article  Google Scholar 

  32. Desborough JP (2000) The stress response to trauma and surgery. Br J Anaesth 85: 109–117

    Article  PubMed  CAS  Google Scholar 

  33. Dorje P, Adhikary G, Tempe DK (2000) Avoiding latrogenic hyperchloremic acidosis–call for a new crystalloid fluid. Anesthesiology 92: 625–626

    Article  PubMed  CAS  Google Scholar 

  34. Dosios T, Billis A, Skalkeas G (1974) Evaporative water loss of adult surgical patients in Greece. Am J Surg 128: 15–18

    Article  PubMed  CAS  Google Scholar 

  35. Elebute EA (1969) Evaporative fluid loss in adult Nigerian males. Br J Surg 56: 213–216

    Article  PubMed  CAS  Google Scholar 

  36. Entholzner E, Mielke L, Plotz W et al. (1994) Hypervolemic hemodilution as a means of preventing homologous blood transfusion. A simple alternative to acute normovolemic hemodilution. Fortschr Med 112: 410–414

    PubMed  CAS  Google Scholar 

  37. Fahraeus R (1928) Die Strömungsverhältnisse und die Verteilung der Blutzellen im Gefäßsystem. Klin Wochenschr 7: 100–106

    Article  Google Scholar 

  38. Finfer S, Bellomo R, Boyce N et al. (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350: 2247–2256

    Article  PubMed  CAS  Google Scholar 

  39. Finsterer U, Brechtelsbauer, Prucksunand P et al. (1975) Sodium and water balance in the dog under halothane and methoxyflurane anesthesia (author’s transl). Anaesthesist 24: 444–454

    PubMed  CAS  Google Scholar 

  40. Finsterer U, Weber W, Luhr HG (1980) Electrolyte balance in major abdominal surgery. III. On insensible water losses from the peritoneal cavity (author’s transl). Anaesthesist 29: 59–70

    PubMed  CAS  Google Scholar 

  41. Gan TJ, Soppitt A, Maroof M et al. (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97: 820–826

    Article  PubMed  Google Scholar 

  42. Garnett RL, MacIntyre A, Lindsay P et al. (1996) Perioperative ischaemia in aortic surgery: Combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and i.v. analgesia. Can J Anaesth 43: 769–777

    PubMed  CAS  Google Scholar 

  43. Goy RW, Chiu JW, Loo CC (2001) Pulse dye densitometry: A novel bedside monitor of circulating blood volume. Ann Acad Med Singapore 30: 192–198

    PubMed  CAS  Google Scholar 

  44. Grebe D, Sander M, Heymann HC von, Carl M, Spies CD (2006) Fluid therapy – pathophysiological principles as well as intra- and perioperative monitoring. Anasthesiol Intensivmed Notfallmed Schmerzther 41: 392–398

    Article  PubMed  Google Scholar 

  45. Grocott MP, Mythen MG, Gan TJ (2005) Perioperative fluid management and clinical outcomes in adults. Anesth Analg 100: 1093–1106

    Article  PubMed  Google Scholar 

  46. Gutelius JR, Shizgal HM, Lopez G (1968) The effect of trauma on extracellular water volume. Arch Surg 97: 206–214

    PubMed  CAS  Google Scholar 

  47. Hadzic A (2007) Textbook of Regional Anesthesia and Acute Pain Management. McGraw-Hill Companies, New York

  48. Healy TE, Paul RK (2003) A Practice of Anesthesia. 7th edition, Arnold, London

  49. Heck M, Fresenius M (2007) Repetitorium Anästhesiologie. 5. Auflage, Springer, Heidelberg

  50. Hendrikson EC, Seacat JM, Neville MC (1985) Insensible weight loss in children under one year of age. Acta Paediatr Scand 74: 678–680

    PubMed  CAS  Google Scholar 

  51. Henry CB, Duling BR (2000) TNF-alpha increases entry of macromolecules into luminal endothelial cell glycocalyx. Am J Physiol Heart Circ Physiol 279: H2815–H2823

    PubMed  CAS  Google Scholar 

  52. Hillebrecht A, Schulz H, Meyer M et al. (1992) Pulmonary responses to lower body negative pressure and fluid loading during head-down tilt bedrest. Acta Physiol Scand Suppl 604: 35–42

    PubMed  CAS  Google Scholar 

  53. Hindmarsh JT, Clark RG (1967) The influence of fluid and electrolyte administration on postoperative weight-loss. Br J Surg 54: 872–874

    Article  PubMed  CAS  Google Scholar 

  54. Holte K, Jensen P, Kehlet H (2003) Physiologic effects of intravenous fluid administration in healthy volunteers. Anesth Analg 96: 1504–1509

    Article  PubMed  Google Scholar 

  55. Holte K, Kehlet H (2002) Compensatory fluid administration for preoperative dehydration – does it improve outcome? Acta Anaesthesiol Scand 46: 1089–1093

    Article  PubMed  CAS  Google Scholar 

  56. Holte K, Kehlet H (2006) Fluid therapy and surgical outcomes in elective surgery: A need for reassessment in fast-track surgery. J Am Coll Surg 202: 971–989

    Article  PubMed  Google Scholar 

  57. Holte K, Klarskov B, Christensen DS et al. (2004) Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: A randomized, double-blind study. Ann Surg 240: 892–899

    Article  PubMed  Google Scholar 

  58. Holte K, Sharrock NE, Kehlet H (2002) Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 89: 622–632

    Article  PubMed  CAS  Google Scholar 

  59. Hu X, Adamson RH, Liu B et al. (2000) Starling forces that oppose filtration after tissue oncotic pressure is increased. Am J Physiol Heart Circ Physiol 279: H1724–H1736

    PubMed  CAS  Google Scholar 

  60. Huttmann A (1951) Perspiratio insensibilis negativa in liver cirrhosis and diabetes insipidus. Z Gesamte Inn Med 6: 562–567

    PubMed  CAS  Google Scholar 

  61. Huxley VH, Meyer DJ Jr. (1988) Atrial natriuretic peptide (ANP)-induced increase in capillary albumin and water flux. Adv Exp Med Biol 242: 23–31

    PubMed  CAS  Google Scholar 

  62. Iijima T, Aoyagi T, Iwao Y et al. (1997) Cardiac output and circulating blood volume analysis by pulse dye-densitometry. J Clin Monit 13: 81–89

    Article  PubMed  CAS  Google Scholar 

  63. Iijima T, Iwao Y, Sankawa H (1998) Circulating blood volume measured by pulse dye-densitometry: Comparison with (131)I-HSA analysis. Anesthesiology 89: 1329–1335

    Article  PubMed  CAS  Google Scholar 

  64. Imai T, Takahashi K, Goto F, Morishita Y (1998) Measurement of blood concentration of indocyanine green by pulse dye densitometry–comparison with the conventional spectrophotometric method. J Clin Monit Comput 14: 477–484

    Article  PubMed  CAS  Google Scholar 

  65. Ishihara H, Ishida K, Oyama T et al. (1978) Effects of general anaesthesia and surgery on renal function and plasma ADH levels. Can Anaesth Soc J 25: 312–318

    PubMed  CAS  Google Scholar 

  66. Jackson R, Reid JA, Thorburn J (1995) Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 75: 262–265

    PubMed  CAS  Google Scholar 

  67. Jacob M, Bruegger D, Rehm M et al. (2007) The endothelial glycocalyx affords compatibility of Starling‚s principle and high cardiac interstitial albumin levels. Cardiovasc Res 73: 575–586

    Article  PubMed  CAS  Google Scholar 

  68. Jacob M, Bruegger D, Rehm M et al. (2006) Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability. Anesthesiology 104: 1223–1231

    Article  PubMed  CAS  Google Scholar 

  69. Jacob M, Chappell D, Rehm M (2007) Clinical update: Perioperative fluid management. Lancet 369: 1984–1986

    Article  PubMed  Google Scholar 

  70. Jacob M, Conzen P, Finsterer U et al. (2007) Technical and physiological background of plasma volume measurement with Indocyanine Green – a clarification of misunderstandings. J Appl Physiol 102: 1235–1242

    Article  PubMed  CAS  Google Scholar 

  71. Jacob M, Rehm M, Orth V et al. (2003) Exact measurement of the volume effect of 6% hydoxyethyl starch 130/0.4 (Voluven) during acute preoperative normovolemic hemodilution. Anaesthesist 52: 896–904

    Article  PubMed  CAS  Google Scholar 

  72. Jaworska H, Gregorek H, Madalinski K (2000) Angioedema is caused by a defect in C1-inhibitor synthesis. Przegl Lek 57: 483–488

    PubMed  CAS  Google Scholar 

  73. Jonsson K, Jensen JA, Goodson WH III et al. (1991) Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 214: 605–613

    Article  PubMed  CAS  Google Scholar 

  74. Kamp-Jensen M, Olesen KL, Bach V et al. (1990) Changes in serum electrolyte and atrial natriuretic peptide concentrations, acid-base and haemodynamic status after rapid infusion of isotonic saline and Ringer lactate solution in healthy volunteers. Br J Anaesth 64: 606–610

    Article  PubMed  CAS  Google Scholar 

  75. Kaneider NC, Egger P, Djanani AM, Wiedermann CJ (2003) Leukocyte motility in response to neuropeptides is heparan sulfate proteoglycan dependent. Peptides 24: 695–700

    Article  PubMed  CAS  Google Scholar 

  76. Karinen J, Rasanen J, Alahuhta S et al. (1995) Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean section. Br J Anaesth 75: 531–535

    PubMed  CAS  Google Scholar 

  77. Kinsella SM, Pirlet M, Mills MS et al. (2000) Randomized study of intravenous fluid preload before epidural analgesia during labour. Br J Anaesth 85: 311–313

    Article  PubMed  CAS  Google Scholar 

  78. Kleinschmidt S (2005) Viel oder wenig Flüssigkeitsinfusion bei abdominellen Eingriffen. Anaesthesist 54: 927–928

    Article  Google Scholar 

  79. Klinke R, Pape H, Silbernagl S (Hrsg) (2005) Lehrbuch der Physiologie. Georg Thieme Verlag, Stuttgart

  80. Kox WJ, Spies C (Hrsg) (2005) Check-up Anästhesiologie. 2. Auflage, Springer, Berlin

  81. Kuhn MM (1991) Colloids vs crystalloids. Crit Care Nurse 11: 37–51

    PubMed  CAS  Google Scholar 

  82. Ladegaard-Pedersen HJ, Engell HC (1975) A comparison between the changes in the distribution volumes of inulin and [51Cr]EDTA after major surgery. Scand J Clin Lab Invest 35: 109–113

    PubMed  CAS  Google Scholar 

  83. Lamke LO, Nilsson GE, Reithner HL (1977) Insensible perspiration from the skin under standardized environmental conditions. Scand J Clin Lab Invest 37: 325–331

    PubMed  CAS  Google Scholar 

  84. Lamke LO, Nilsson GE, Reithner HL (1977) Water loss by evaporation from the abdominal cavity during surgery. Acta Chir Scand 143: 279–284

    PubMed  CAS  Google Scholar 

  85. Lang K, Boldt J, Suttner S, Haisch G (2001) Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 93: 405–409

    Article  PubMed  CAS  Google Scholar 

  86. Larkin JM, Moylan JA (1978) Evaporative water losses in patients treated in a laminar flow burn unit. J Surg Res 24: 65–69

    Article  PubMed  CAS  Google Scholar 

  87. Larsen R (Hrsg) (1990) Anästhesie. 5. Aufl. Urban & Schwarzenberg, München

  88. Lee RW, Di GD, May C, Bellomo R (2004) Vasoactive drugs and the kidney. Best Pract Res Clin Anaesthesiol 18: 53–74

    Article  PubMed  CAS  Google Scholar 

  89. Levick JR (1980) Contributions of the lymphatic and microvascular systems to fluid absorption from the synovial cavity of the rabbit knee. J Physiol 306: 445–461

    PubMed  CAS  Google Scholar 

  90. Lewis H, Wilkins M, Selwyn B et al. (1989) Relationship between ANP, cyclic GMP and tissue kallikrein following saline infusion in healthy volunteers. Adv Exp Med Biol 247A: 281–286

    PubMed  CAS  Google Scholar 

  91. Lobo DN, Bostock KA, Neal KR et al. (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: A randomised controlled trial. Lancet 359: 1812–1818

    Article  PubMed  Google Scholar 

  92. Loon N, Chagnac A, Parra L et al. (1992) Filtration dynamics and natriuretic response to volume expansion in humans. Am J Physiol 263: F284–F292

    PubMed  CAS  Google Scholar 

  93. Luft JH (1966) Fine structures of capillary and endocapillary layer as revealed by ruthenium red. Fed Proc 25: 1773–1783

    PubMed  CAS  Google Scholar 

  94. Lutz H (Hrsg) (1986) Anästhesiologische Praxis. 2. Aufl. Springer, Berlin Heidelberg New York

  95. MacKay G, Fearon K, McConnachie A et al. (2006) Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg 93: 1469–1474

    Article  PubMed  CAS  Google Scholar 

  96. Magner JJ, McCaul C, Carton E et al. (2004) Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: Comparison of 30 and 10 ml kg(-1). Br J Anaesth 93: 381–385

    Article  PubMed  CAS  Google Scholar 

  97. Maharaj CH, Kallam SR, Malik A et al. (2005) Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesth Analg 100: 675–682

    Article  PubMed  CAS  Google Scholar 

  98. McCrae AF, Wildsmith JA (1993) Prevention and treatment of hypotension during central neural block. Br J Anaesth 70: 672–680

    Article  PubMed  CAS  Google Scholar 

  99. Mielke LL, Entholzner EK, Kling M et al. (1997) Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: An alternative to acute normovolemic hemodilution? Anesth Analg 84: 26–30

    Article  PubMed  CAS  Google Scholar 

  100. Miller RD (ed) (1999) Anesthesia. 5. Aufl. Churchill Livingston, Philadelphia

  101. Moretti EW, Robertson KM, El-Moalem H, Gan TJ (2003) Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesth Analg 96: 611–617

    Article  PubMed  Google Scholar 

  102. Morgan TJ, Venkatesh B, Hall J (2002) Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution. Crit Care Med 30: 157–160

    Article  PubMed  CAS  Google Scholar 

  103. Mortelmans YJ, Vermaut G, Verbruggen AM et al. (1995) Effects of 6% hydroxyethyl starch and 3% modified fluid gelatin on intravascular volume and coagulation during intraoperative hemodilution. Anesth Analg 81: 1235–1242

    Article  PubMed  CAS  Google Scholar 

  104. Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130: 423–429

    PubMed  CAS  Google Scholar 

  105. Needleman P, Greenwald JE (1986) Atriopeptin: A cardiac hormone intimately involved in fluid, electrolyte, and blood-pressure homeostasis. N Engl J Med 314: 828–834

    Article  PubMed  CAS  Google Scholar 

  106. Nielsen OM, Engell HC (1985) Extracellular fluid volume and distribution in relation to changes in plasma colloid osmotic pressure after major surgery. A randomized study. Acta Chir Scand 151: 221–225

    PubMed  CAS  Google Scholar 

  107. Nielsen OM, Engell HC (1986) The importance of plasma colloid osmotic pressure for interstitial fluid volume and fluid balance after elective abdominal vascular surgery. Ann Surg 203: 25–29

    Article  PubMed  CAS  Google Scholar 

  108. Nieuwdorp M, Meuwese MC, Vink H et al. (2005) The endothelial glycocalyx: A potential barrier between health and vascular disease. Curr Opin Lipidol 16: 507–511

    Article  PubMed  CAS  Google Scholar 

  109. Nieuwdorp M, Haeften TW van, Gouverneur MC et al. (2006) Loss of endothelial glycocalyx during acute hyperglycemia coincides with endothelial dysfunction and coagulation activation in vivo. Diabetes 55: 480–486

    Article  PubMed  CAS  Google Scholar 

  110. Nisanevich V, Felsenstein I, Almogy G et al. (2005) Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103: 25–32

    Article  PubMed  Google Scholar 

  111. Nishimura N, Kajimoto Y, Kabe T, Sakamoto A (1985) The effects of volume loading during epidural analgesia. Resuscitation 13: 31–40

    Article  PubMed  CAS  Google Scholar 

  112. Noblett SE, Snowden CP, Shenton BK, Horgan AF (2006) Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 93: 1069–1076

    Article  PubMed  CAS  Google Scholar 

  113. Paquin AJ Jr (1958) Insensible body weight los following uniformly severe surgical trauma. Ann Surg 148: 937–942

    Article  PubMed  Google Scholar 

  114. Parquin F, Marchal M, Mehiri S et al. (1996) Post-pneumonectomy pulmonary edema: Analysis and risk factors. Eur J Cardiothorac Surg 10: 929–932

    Article  PubMed  CAS  Google Scholar 

  115. Parving HH, Rossing N, Nielsen SL, Lassen NA (1974) Increased transcapillary escape rate of albumin, IgG, and IgM after plasma volume expansion. Am J Physiol 227: 245–250

    PubMed  CAS  Google Scholar 

  116. Paut O, Lacroix F (2006) Recent developments in the perioperative fluid management for the paediatric patient. Curr Opin Anaesthesiol 19: 268–277

    Article  PubMed  Google Scholar 

  117. Pearson TC, Guthrie DL, Simpson J et al. (1995) Interpretation of measured red cell mass and plasma volume in adults: Expert Panel on Radionuclides of the International Council for Standardization in Haematology. Br J Haematol 89: 748–756

    Article  PubMed  CAS  Google Scholar 

  118. Perko MJ, Jarnvig IL, Hojgaard-Rasmussen N et al. (2001) Electric impedance for evaluation of body fluid balance in cardiac surgical patients. J Cardiothorac Vasc Anesth 15: 44–48

    Article  PubMed  CAS  Google Scholar 

  119. Peter K, Frey L, Hobbhahn J (Hrsg) (1989) Anästhesiologie. Enke Verlag, Stuttgart

  120. Pouta AM, Karinen J, Vuolteenaho OJ, Laatikainen TJ (1996) Effect of intravenous fluid preload on vasoactive peptide secretion during Caesarean section under spinal anaesthesia. Anaesthesia 51: 128–132

    Article  PubMed  CAS  Google Scholar 

  121. Priano LL, Smith JD, Cohen JI, Everts EE (1993) Intravenous fluid administration and urine output during radical neck surgery. Head Neck 15: 208–215

    Article  PubMed  CAS  Google Scholar 

  122. Prien T, Backhaus N, Pelster F et al. (1990) Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth 2: 317–323

    Article  PubMed  CAS  Google Scholar 

  123. Pries AR, Kuebler WM (2006) Normal endothelium. Handb Exp Pharmacol 176: 1–40

    PubMed  Google Scholar 

  124. Pries AR, Secomb TW, Gaehtgens P (2000) The endothelial surface layer. Pflugers Arch 440: 653–666

    Article  PubMed  CAS  Google Scholar 

  125. Pschyrembel (2004) Klinisches Wörterbuch. 260. Aufl. Walter de Gruyter Verlag, Berlin

  126. Ratner LE, Smith GW (1993) Intraoperative fluid management. Surg Clin North Am 73: 229–241

    PubMed  CAS  Google Scholar 

  127. Redden M, Wotton K (2002) Third-space fluid shift in elderly patients undergoing gastrointestinal surgery: Part 1: Pathophysiological mechanisms. Contemp Nurse 12: 275–283

    PubMed  Google Scholar 

  128. Rehm M, Conzen PF, Peter K, Finsterer U (2004) The Stewart model. „Modern“ approach to the interpretation of the acid-base metabolism. Anaesthesist 53: 347–357

    Article  PubMed  CAS  Google Scholar 

  129. Rehm M, Haller M, Brechtelsbauer H et al. (1998) Extra protein loss not caused by surgical bleeding in patients with ovarian cancer. Acta Anaesthesiol Scand 42: 39–46

    Article  PubMed  CAS  Google Scholar 

  130. Rehm M, Haller M, Orth V et al. (2001) Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy. Anesthesiology 95: 849–856

    Article  PubMed  CAS  Google Scholar 

  131. Rehm M, Orth V, Kreimeier U et al. (2000) Changes in intravascular volume during acute normovolemic hemodilution and intraoperative retransfusion in patients with radical hysterectomy. Anesthesiology 92: 657–664

    Article  PubMed  CAS  Google Scholar 

  132. Rehm M, Orth VH, Kreimeier U et al. (2001) Changes in blood volume during acute normovolemic hemodilution with 5% albumin or 6% hydroxyethylstarch and intraoperative retransfusion. Anaesthesist 50: 569–579

    Article  PubMed  CAS  Google Scholar 

  133. Rehm M, Zahler S, Lotsch M et al. (2004) Endothelial glycocalyx as an additional barrier determining extravasation of 6% hydroxyethyl starch or 5% albumin solutions in the coronary vascular bed. Anesthesiology 100: 1211–1223

    Article  PubMed  CAS  Google Scholar 

  134. Reid F, Lobo DN, Williams RN et al. (2003) (Ab)normal saline and physiological Hartmann’s solution: A randomized double-blind crossover study. Clin Sci (Lond) 104: 17–24

    Google Scholar 

  135. Reissman P, Teoh TA, Cohen SM et al. (1995) Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 222: 73–77

    Article  PubMed  CAS  Google Scholar 

  136. Reithner L, Johansson H, Strouth L (1980) Insensible perspiration during anaesthesia and surgery. Acta Anaesthesiol Scand 24: 362–366

    PubMed  CAS  Google Scholar 

  137. Robarts WM (1979) Nature of the disturbance in the body fluid compartments during and after surgical operations. Br J Surg 66: 691–695

    Article  PubMed  CAS  Google Scholar 

  138. Roberts I, Alderson P, Bunn F et al. (2004) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 4: CD000567

    PubMed  Google Scholar 

  139. Roberts JP, Roberts JD, Skinner C et al. (1985) Extracellular fluid deficit following operation and its correction with Ringer’s lactate. A reassessment. Ann Surg 202: 1–8

    Article  PubMed  CAS  Google Scholar 

  140. Roe CF, Kinney JM (1964) Water and heat exchang ein third-degree burns. Surgery 56: 212–220

    PubMed  CAS  Google Scholar 

  141. Rossaint R, Werner C, Zwißler B (Hrsg) (2004) Die Anästhesiologie. Springer, Berlin Heidelberg

  142. Roth E, Lax LC, Maloney JV Jr (1969) Ringer’s lactate solution and extracellular fluid volume in the surgical patient: A critical analysis. Ann Surg 169: 149–164

    Article  PubMed  CAS  Google Scholar 

  143. Rothe R, Till C (1968) The problem of participation of metabolic processes in the perspiratio insensibilis. Arch Phys Ther (Leipz) 20: 381–384

    Google Scholar 

  144. Rout CC, Akoojee SS, Rocke DA, Gouws E (1992) Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth 68: 394–397

    Article  PubMed  CAS  Google Scholar 

  145. Saricaoglu F, Akinci SB, Celiker V, Aypar U (2005) The effect of acute normovolemic hemodilution and acute hypervolemic hemodilution on coagulation and allogeneic transfusion. Saudi Med J 26: 792–798

    PubMed  Google Scholar 

  146. Schmidt RF, Lang F, Thews G (Hrsg) (2006) Physiologie des Menschen. 28. Aufl. Springer, Berlin

  147. Schulte am Esch J, Kochs E, Brause H (Hrsg) (2000) Anästhesie und Intensivmedizin. Thieme Verlag, Stuttgart

  148. Schutten HJ, Johannessen AC, Torp-Pedersen C et al. (1987) Central venous pressure–a physiological stimulus for secretion of atrial natriuretic peptide in humans? Acta Physiol Scand 131: 265–272

    PubMed  CAS  Google Scholar 

  149. Sear JW (2005) Kidney dysfunction in the postoperative period. Br J Anaesth 95: 20–32

    Article  PubMed  CAS  Google Scholar 

  150. Shackford SR, Fortlage DA, Peters RM et al. (1987) Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction. Surg Gynecol Obstet 164: 127–136

    PubMed  CAS  Google Scholar 

  151. Shackford SR, Sise MJ, Fridlund PH et al. (1983) Hypertonic sodium lactate versus lactated ringer’s solution for intravenous fluid therapy in operations on the abdominal aorta. Surgery 94: 41–51

    PubMed  CAS  Google Scholar 

  152. Shires T, Coln D, Carrico J, Lightfoot S (1964) Fluid therapy in hemorrhagic shock. Arch Surg 88: 688–693

    PubMed  CAS  Google Scholar 

  153. Shires T, Jackson DE (1962) Postoperative salt tolerance. Arch Surg 84: 703–706

    PubMed  CAS  Google Scholar 

  154. Shires T, Williams J, Brown F (1961) Acute change in extracellular fluids associated with major surgical procedures. Ann Surg 154: 803–810

    Article  PubMed  CAS  Google Scholar 

  155. Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315: 909–912

    PubMed  CAS  Google Scholar 

  156. Slinger PD (1995) Perioperative fluid management for thoracic surgery: The puzzle of postpneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth 9: 442–451

    Article  PubMed  CAS  Google Scholar 

  157. Spahn DR, Chassot PG (2006) CON: Fluid restriction for cardiac patients during major noncardiac surgery should be replaced by goal-directed intravascular fluid administration. Anesth Analg 102: 344–346

    Article  PubMed  Google Scholar 

  158. Steed HL, Capstick V, Flood C et al. (2002) A randomized controlled trial of early versus „traditional“ postoperative oral intake after major abdominal gynecologic surgery. Am J Obstet Gynecol 186: 861–865

    Article  PubMed  Google Scholar 

  159. Tinckler LF (1966) Fluid and electrolyte observations in tropical surgical practice. Br Med J 5498: 1263–1267

    Google Scholar 

  160. Trolle C (2006) A study of the insensible perspiration in man and its nature. Skand Arch Physiol 76: 225–246

    Google Scholar 

  161. Tucker VL, Simanonok KE, Renkin EM (1992) Tissue-specific effects of physiological ANP infusion on blood-tissue albumin transport. Am J Physiol 263: R945–R953

    PubMed  CAS  Google Scholar 

  162. Venn R, Steele A, Richardson P et al. (2002) Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 88: 65–71

    Article  PubMed  CAS  Google Scholar 

  163. Vink H, Constantinescu AA, Spaan JA (2000) Oxidized lipoproteins degrade the endothelial surface layer: Implications for platelet-endothelial cell adhesion. Circulation 101: 1500–1502

    PubMed  CAS  Google Scholar 

  164. Virtue RW, LeVine DS, Aikawa JK (1966) Fluid shifts during the surgical period: RISA and S35 determiniations following glucose, saline or lactate infusion. Ann Surg 163: 523–528

    Article  PubMed  CAS  Google Scholar 

  165. Vogel J, Sperandio M, Pries AR et al. (2000) Influence of the endothelial glycocalyx on cerebral blood flow in mice. J Cereb Blood Flow Metab 20: 1571–1578

    Article  PubMed  CAS  Google Scholar 

  166. Wagener HH (1967) Quantitative and topographic studies on perspiratio insensibilis in man. Arch Klin Exp Dermatol 229: 174–181

    Article  PubMed  CAS  Google Scholar 

  167. Wakim KG (1970) „Normal“ 0.9 per cent salt solution is neither „normal“ nor physiological. JAMA 214: 1710

    Article  PubMed  CAS  Google Scholar 

  168. Waters JH, Gottlieb A, Schoenwald P et al. (2001) Normal saline versus lactated Ringer’s solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg 93: 817–822

    Article  PubMed  CAS  Google Scholar 

  169. Wiedemann HP, Wheeler AP, Bernard GR et al. (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354: 2564–2575

    Article  PubMed  CAS  Google Scholar 

  170. Wilmore DW (2000) Metabolic response to severe surgical illness: overview. World J Surg 24: 705–711

    Article  PubMed  CAS  Google Scholar 

  171. Wilmore DW, Smith RJ, O’Dwyer ST et al. (1988) The gut: A central organ after surgical stress. Surgery 104: 917–923

    PubMed  CAS  Google Scholar 

  172. Winter V, Gille J, Richter A et al. (2006) Preoperative hypervolemic hemodilution with 6% hydroxyethyl starch 130/0,4 (HES 130/ 0.4) solution as a way of reducing needs for donor blood transfusion. Anesteziol Reanimatol:43–47

    Google Scholar 

  173. Woerlee GM (ed) (1988) Common perioperative problems and the anaesthetist. Kluwer Academic Publishers, Dordrecht Boston London

  174. Yamaji T, Ishibashi M, Takaku F (1985) Atrial natriuretic factor in human blood. J Clin Invest 76: 1705–1709

    Article  PubMed  CAS  Google Scholar 

  175. Zander R (Hrsg) (2006) Flüssigkeitstherapie. Bibliomed – Medizinische Verlagsgesellschaft mbH, Melsungen

  176. Zander R, Adams HA, Boldt J et al. (2005) Requirements and expectations for optimal volume replacement. Anasthesiol Intensivmed Notfallmed Schmerzther 40: 701–719

    Article  PubMed  CAS  Google Scholar 

  177. Zeldin RA, Normandin D, Landtwing D, Peters RM (1984) Postpneumonectomy pulmonary edema. J Thorac Cardiovasc Surg 87: 359–365

    PubMed  CAS  Google Scholar 

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  1. Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München Großhadern-Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland

    M. Jacob, D. Chappell, K. Hofmann-Kiefer, P. Conzen, K. Peter & M. Rehm

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  2. D. Chappell
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Jacob, M., Chappell, D., Hofmann-Kiefer, K. et al. Determinanten des insensiblen Flüssigkeitsverlustes. Anaesthesist 56, 747–764 (2007). https://doi.org/10.1007/s00101-007-1235-4

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