Crystalloid-Induced Endothelial Glycocalyx Degradation

Introduction to Crystalloid-Induced Damage

• The administration of large volumes of 0.9% saline solution can cause metabolic acidosis, hyperchloremia, renal vasoconstriction, and acute kidney injury, as reported by the British Journal of Anaesthesia 1

Fluid Management Strategies

• The European Society of Anaesthesiology (2024) recommends the use of balanced crystalloids over 0.9% saline solution for perioperative fluid management, with high-quality evidence 3, 1
• For patients with sepsis or septic shock, balanced crystalloids are probably recommended over 0.9% saline solution as first-line therapy to reduce mortality and renal adverse events 4

Considerations for Fluid Administration

• The administration of an adequate volume of fluids during surgery, generally aiming for a positive balance of 1-2 L at the end of the case, is recommended to protect renal function without causing volume overload, as suggested by the British Journal of Anaesthesia 3

Alternative Fluid Management Options

• The use of hydroxyethyl starch (HES) is contraindicated in critically ill patients due to increased risk of mortality, acute kidney injury, and coagulation disorders, as reported by Anaesthesia 5
• The European Medicines Agency recommended in 2013 that HES no longer be used for volume resuscitation, particularly in patients with sepsis, as mentioned in Anaesthesia 5