The issue is not, however, without controversy. A lack of uniform fluid administration in the ‘standard’ and ‘restricted’ groups within controlled trials makes comparison and meta-analysis problematic. Assessment of fluid status before and after an intervention is notoriously difficult. Insensible losses and loss into the infamous non-anatomical ‘third space’ are hard to calculate, and their importance has been questioned6. As assessment and tailored treatment are skill dependent, fluid therapy is not optimally suited for randomized comparison. Furthermore, we should not see more randomized trials with a truly overloaded control group. Hence, fluid therapy, even in dedicated hands, is still short of having an acceptable evidence base6, and will probably remain so for some time. The British Consensus Guidelines reflect this insofar as several recommendations are made on level 5 evidence. Evidence alone, however, is not enough to change traditional practice2. Guidelines do not change inadequate care without a dedicated local plan for their implementation.
The issue is not, however, without controversy. A lack of uniform fluid administration in the ‘standard’ and ‘restricted’ groups within controlled trials makes comparison and meta-analysis problematic. Assessment of fluid status before and after an intervention is notoriously difficult. Insensible losses and loss into the infamous non-anatomical ‘third space’ are hard to calculate, and their importance has been questioned6. As assessment and tailored treatment are skill dependent, fluid therapy is not optimally suited for randomized comparison. Furthermore, we should not see more randomized trials with a truly overloaded control group. Hence, fluid therapy, even in dedicated hands, is still short of having an acceptable evidence base6, and will probably remain so for some time. The British Consensus Guidelines reflect this insofar as several recommendations are made on level 5 evidence. Evidence alone, however, is not enough to change traditional practice2. Guidelines do not change inadequate care without a dedicated local plan for their implementation.
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