Fluid management in the thoracic surgical patient: where is the balance?

Pulmonary complications (PPCs) following lung resection are common and have a significant negative impact on the patients recovery after lung resection surgery as well as economic effect on health resource usage (1,2). A restrictive fluid strategy has been a long-standing dogma of such surgery which has been repeatedly challenged not only in terms of causality but because of potential deleterious effects on kidney function. The optimal fluid balance in the thoracic surgical patient during the perioperative period and its possible association with the development of PPCs has generated a long debate (3-5).