An Integrative Review of Fluid Management in Cardiac Surgery

Adequate fluid administration during and after cardiac surgery is essential to ensure adequate oxygen delivery to the tissues, while simultaneously avoiding the dangers of hypervolemia and fluid overload. In both cardiac and non-cardiac surgery there has been debate on what the best approach to fluid management is, what hemodynamic parameters should be used to assess fluid requirements, and what type of fluids should be used. There are several studies in non-cardiac surgery that examine these issues, while they are fewer in the field of cardiac surgery. An integrative review design was used to examine the current evidence on fluid management practices in cardiac surgery. Thirteen studies were included in this review. They included four studies of surveys on fluid management practices, eight studies that utilized goal directed therapy (GDT), and one observational study on fluid administration practices in cardiac surgical patients. The results showed that arterial blood pressure (ABP), central venous pressure (CVP), and echocardiography were used most often to monitor volume status. Crystalloids were used most frequently for volume replacement. In the studies utilizing GDT, fluid administration was often based on stroke volume variation (SVV) and cardiac index (CI) goals. A slight trend towards increased fluid administration was seen in the GDT groups. Fluid bolus volumes ranged from 100 to 500 ml. The GDT groups had a slight trend toward decreased length of both hospital and ICU stay. An important limitation of the review was that none of the studies were conducted in the United States of America.