Fluid Management During and After the Operation: Less Is More or More Is Less?

Lung injury following thoracic surgery is a major cause of morbidity and mortality. A consistent risk factor is excessive perioperative fluid administration, not only following pneumonectomy but also after lesser lung resections and esophageal surgery. Recent insights into the pathophysiology of lung injury after thoracic surgery include the role of the endothelial glycocalyx, pulmonary endothelium, lung lymphatics, and right ventricular dysfunction. While a restrictive approach to fluid administration may reduce the risk of lung injury, there are concerns regarding the risks of acute kidney injury with this approach. Goal-directed approaches may be applied to the thoracic surgical population, and lung ultrasound appears to be a promising new technique to further guide perioperative fluid therapy. There is a paucity of data to guide the choice of crystalloid or colloid solution. Further research is required regarding prevention, diagnosis, and treatment of lung injury following thoracic surgery.