Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 2 , Pages 145-157 , June 2009

The ‘third space’ – fact or fiction?

  • Matthias Jacob, MD (Staff Anesthesiologist)

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +49 89 5160 2691; Fax: +49 89 5160 4446.
    • Both authors equally contributed to this work.
    • ,
  • Daniel Chappell, MD (Staff Anesthesiologist)

      Affiliations

    • Both authors equally contributed to this work.
    • ,
  • Markus Rehm, MD (Associate Professor)

References 

  1. Adamson RH, Lenz JF, Zhang X, et al. Oncotic pressures opposing filtration across non-fenestrated rat microvessels. The Journal of Physiology. 2004;557:889–907
  2. Boldt J. Volume therapy in cardiac surgery: are Americans different from Europeans?. Journal of Cardiothoracic and Vascular Anesthesia. 2006;20:98–105
  3. Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid therapy. Anesthesiology. 2008;109:723–740
  4. Chappell D, Jacob M, Becker BF, et al. Expedition glycocalyx. A newly discovered ‘Great Barrier Reef’. Anaesthesist. 2008;57:959–969
  5. Holte K, Kehlet H. Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. Journal of the American College of Surgeons. 2006;202:971–989
  6. Jacob M, Chappell D, Rehm M. Clinical update: perioperative fluid management. Lancet. 2007;369:1984–1986
  7. Jacob M, Chappell D, Hofmann-Kiefer K, et al. Determinants of insensible fluid loss. Perspiration, protein shift and endothelial glycocalyx. Anaesthesist. 2007;56:747–764
  8. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesthesia and Analgesia. 2005;101:601–605
  9. Pries AR, Kuebler WM. Normal endothelium. Handbook of Experimental Pharmacology. 2006;1:1–40
  10. Bellomo R. Fluid resuscitation: colloids vs. crystalloids. Blood Purification. 2000;20:239–242
  11. Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Critical Care Medicine. 1999;27:200–210
  12. Dorje P, Adhikary G, Tempe DK. Avoiding latrogenic hyperchloremic acidosis – call for a new crystalloid fluid. Anesthesiology. 2000;92:625–626
  13. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Annals of Surgery. 2003;238:641–648
  14. Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005;103:25–32
  15. Boldt J, Ducke M, Kumle B, et al. Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery. Intensive Care Medicine. 2004;30:416–422
  16. Campbell IT, Baxter JN, Tweedie IE, et al. IV fluids during surgery. British Journal of Anaesthesia. 1990;65:726–729
  17. Dawidson IJ, Willms CD, Sandor ZF, et al. Ringer's lactate with or without 3% dextran-60 as volume expanders during abdominal aortic surgery. Critical Care Medicine. 1991;19:36–42
  18. Holte K, Klarskov B, Christensen DS, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Annals of Surgery. 2004;240:892–899
  19. Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesthesia and Analgesia. 2001;93:405–409
  20. Maharaj CH, Kallam SR, Malik A, et al. Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesthesia and Analgesia. 2005;100:675–682
  21. Waters JH, Gottlieb A, Schoenwald P, et al. Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesthesia and Analgesia. 2001;93:817–822
  22. Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration – does it improve outcome?. Acta Anaesthesiologica Scandinavica. 2002;46:1089–1093
  23. Coe AJ, Revanas B. Is crystalloid preloading useful in spinal anaesthesia in the elderly?. Anaesthesia. 1990;45:241–243
  24. McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. British Journal of Anaesthesia. 1993;70:672–680
  25. Sear JW. Kidney dysfunction in the postoperative period. British Journal of Anaesthesia. 2005;95:20–32
  26. Kaye AD, Kucera AJ. Fluid and electrolyte physiology. In:  Miller RD editors. Anesthesia. Philadelphia: Churchill Livingston; 2005;p. 1763–1798
  27. Haugen O, Farstad M, Kvalheim V, et al. Elevated flow rate during cardiopulmonary bypass is associated with fluid accumulation. The Journal of Thoracic and Cardiovascular Surgery. 2007;134:587–593
  28. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812–1818
  29. Rehm M, Orth V, Kreimeier U, et al. Changes in intravascular volume during acute normovolemic hemodilution and intraoperative retransfusion in patients with radical hysterectomy. Anesthesiology. 2000;92:657–664
  30. Rehm M, Haller M, Orth V, et al. Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy. Anesthesiology. 2001;95:849–856
  31. Shackford SR, Sise MJ, Fridlund PH, et al. Hypertonic sodium lactate versus lactated ringer's solution for intravenous fluid therapy in operations on the abdominal aorta. Surgery. 1983;94:41–51
  32. Shackford SR, Fortlage DA, Peters RM, et al. Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction. Surgery Gynecology & Obstetrics. 1987;164:127–136
  33. Kudsk KA. Evidence for conservative fluid administration following elective surgery. Annals of Surgery. 2003;238:649–650
  34. Boldt J, Haisch G, Suttner S, et al. Are lactated Ringer's solution and normal saline solution equal with regard to coagulation?. Anesthesia and Analgesia. 2002;94:378–384
  35. Virgilio RW, Rice CL, Smith DE, et al. Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery. 1979;85:129–139
  36. Lamke LO, Nilsson GE, Reithner HL. Water loss by evaporation from the abdominal cavity during surgery. Acta Chirurgica Scandinavica. 1977;143:279–284
  37. Jacob M, Chappell D, Conzen P, et al. Blood volume is normal after preoperative overnight fasting. Acta Anaesthesiologica Scandinavica. 2008;52:522–529
  38. Soreide E, Eriksson LI, Hirlekar G, et al. Pre-operative fasting guidelines: an update. Acta Anaesthesiologica Scandinavica. 2005;49:1041–1047
  39. Jacob M, Rehm M, Orth V, et al. Exact measurement of the volume effect of 6% hydoxyethyl starch 130/0.4 (Voluven) during acute preoperative normovolemic hemodilution. Anaesthesist. 2003;52:896–904
  40. Tatara T, Tashiro C. Quantitative analysis of fluid balance during abdominal surgery. Anesthesia and Analgesia. 2007;104:347–354
  41. Chan ST, Kapadia CR, Johnson AW, et al. Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses. British Journal of Surgery. 1983;70:36–39
  42. Grocott MP, Mythen MG, Gan TJ. Perioperative fluid management and clinical outcomes in adults. Anesthesia and Analgesia. 2005;100:1093–1106
  43. Brandstrup B. Fluid therapy for the surgical patient. Best Practice & Research. Clinical Anaesthesiology. 2006;20:265–283
  44. Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures. Annals of Surgery. 1961;154:803–810
  45. Carrico CJ, Canizaro PC, Shires GT. Fluid resuscitation following injury: rationale for the use of balanced salt solutions. Critical Care Medicine. 1976;4:46–54
  46. Brandstrup B, Svensen C, Engquist A. Hemorrhage and operation cause a contraction of the extracellular space needing replacement – evidence and implications? A systematic review. Surgery. 2006;139:419–432
  47. Margarson MP, Soni N. Serum albumin: touchstone or totem?. Anaesthesia. 1998;53:789–803
  48. Joles JA, Rabelink TJ, Braam B, Koomans HA. Plasma volume regulation: defences against edema formation (with special emphasis on hypoproteinemia). American Journal of Nephrology. 1993;13:399–412
  49. Roth E, Lax LC, Maloney JV. Ringer's lactate solution and extracellular fluid volume in the surgical patient: a critical analysis. Annals of Surgery. 1969;169:149–164
  50. Woerlee GM. Common perioperative problems and the anaesthetist. Dordrecht: Kluwer Academic Publishers; 1988;
  51. Nielsen OM. Extracellular fluid and colloid osmotic pressure in abdominal vascular surgery. A study of volume changes. Danish Medical Bulletin. 1991;1991(38):9–21
  52. Doty DB, Hufnagel HV, Moseley RV. The distribution of body fluids following hemorrhage and resuscitation in combat casualties. Surgery Gynecology & Obstetrics. 1970;130:453–458
  53. Jacob M, Conzen P, Finsterer U, et al. Technical and physiological background of plasma volume measurement with indocyanine green - a clarification of misunderstandings. Journal of Applied Physiology. 2007;102:1235–1242
  54. Newton WT, Pease HD, Butcher HR. Sodium and sulfate distributions in dogs after hemorrhagic shock. Surgical Forum. 1969;20:1–2
  55. Reid DJ. Intracellular and extracellular fluid volume during surgery. British Journal of Surgery. 1968;55:594–596
  56. Berson SA, Yalow RS. Critique of extracellular space measurements with small ions: Na24 and Br82 spaces. Science. 1955;121:34–36
  57. Vineyard G, Osborne D. Simultaneous determination of extracellular water by 35-sulphate and 82-bromide in dogs, with a note on the acute effects of hypotensive shock. Surgical Forum. 1967;18:37–39
  58. Schloerb P, Peters C, Cage G, et al. Evaluation of the sulphate space as a measure of extracellular fluid. Surgical Forum. 1967;18:39–41
  59. Cleland J, Pluth JR, Tauxe WN, Kirklin JW. Blood volume and body fluid compartment changes soon after closed and open intracardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 1966;52:698–705
  60. Anderson RW, Simmons RL, Collins JA, et al. Plasma volume and sulfate spaces in acute combat casualties. Surgery Gynecology & Obstetrics. 1969;128:719–724
  61. Krejcie TC, Henthorn TK, Gentry WB, et al. Modifications of blood volume alter the disposition of markers of blood volume, extracellular fluid, and total body water. The Journal of Pharmacology and Experimental Therapeutics. 1999;291:1308–1316
  62. Herbst CA. Simultaneous distribution rate and dilution volume of bromide-82 and thiocyanate in body fluid overload: experimental and clinical correlation. Annals of Surgery. 1974;179:200–208
  63. Roberts JP, Roberts JD, Skinner C, et al. Extracellular fluid deficit following operation and its correction with Ringer's lactate. A reassessment. Annals of Surgery. 1985;202:1–8
  64. Carrico CJ, Coln CD, Lightfoot SA, et al. Extracellular fluid volume replacement in hemorrhagic shock. Surgical Forum. 1963;14:10–12
  65. Shires T, Coln D, Carrico J, Lightfoot S. Fluid therapy in hemorrhagic shock. Archives of Surgery. 1964;88:688–693
  66. Fukuda Y, Fujita T, Shibuya J, Albert SN. The distribution between the intravascular and interstitial compartments of commonly utilized replacement fluids. Anesthesia and Analgesia. 1969;48:831–838
  67. Gutelius JR, Shizgal HM, Lopez G. The effect of trauma on extracellular water volume. Archives of Surgery. 1968;97:206–214
  68. Breckenridge IM, Digerness SB, Kirklin JW. Validity of concept of increased extracellular fluid after open heart surgery. Surgical Forum. 1969;20:169–171
  69. Breckenridge IM, Digerness SB, Kirklin JW. Increased extracellular fluid after open intracardiac operation. Surgery Gynecology & Obstetrics. 1970;131:53–56
  70. Gumpert JR, Zollinger RM, Riddell AG. Proceedings: the measurement of extracellular fluid volume with radiobromide simultaneous plasma and lymph disappearance in man. British Journal of Surgery. 1973;60:903
  71. Kragelund E. Loss of fluid and blood to the peritoneal cavity during abdominal surgery. Surgery. 1971;69:284–287
  72. Pacifico AD, Digerness S, Kirklin JW. Acute alterations of body composition after open intracardiac operations. Circulation. 1970;41:331–341
  73. Kragelund E. Changes of the apparent 3HOH, 82Br, 125I human albumin and 51Cr red blood cell dilution volumes before, during and after operation in human subjects. Annals of Surgery. 1970;172:116–124
  74. Nielsen OM, Engell HC. Extracellular fluid volume and distribution in relation to changes in plasma colloid osmotic pressure after major surgery. A randomized study. Acta Chirurgica Scandinavica. 1985;151:221–225
  75. Ladegaard-Pedersen HJ, Engell HC. A comparison of the distribution volumes of inulin and (51 Cr)EDTA in man and nephrectomized dogs. Scandinavian Journal of Clinical and Laboratory Investigation. 1972;30:267–270
  76. Ladegaard-Pedersen H. Inulin distribution volume, plasma volume, and colloid osmotic pressure before and after major surgery. Acta Chirurgica Scandinavica. 1974;140:505–507
  77. Shizgal HM, Solomon S, Gutelius JR. Body water distribution after operation. Surgery Gynecology & Obstetrics. 1977;144:35–41
  78. Magner JJ, McCaul C, Carton E, et al. Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg(-1). British Journal of Anaesthesia. 2004;93:381–385
  79. Holte K, Kristensen BB, Valentiner L, et al. Liberal versus restrictive fluid management in knee arthroplasty: a randomized, double-blind study. Anesthesia and Analgesia. 2007;105:465–474
  80. Stevens T, Garcia JG, Shasby DM, et al. Mechanisms regulating endothelial cell barrier function. American Journal of Physiology. Lung Cellular and Molecular Physiology. 2000;279:L419–L422
  81. Starling E. On the absorption of fluid from the connective tissue spaces. The Journal of Physiology (London). 1896;19:312–326
  82. Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. British Journal of Anaesthesia. 1995;75:262–265
  83. Karinen J, Rasanen J, Alahuhta S, et al. Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean section. British Journal of Anaesthesia. 1995;75:531–535
  84. Kinsella SM, Pirlet M, Mills MS, et al. Randomized study of intravenous fluid preload before epidural analgesia during labour. British Journal of Anaesthesia. 2000;85:311–313
  85. Rout CC, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. British Journal of Anaesthesia. 1992;68:394–397
  86. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest. 1999;115:1371–1377
  87. Kroll W, Polz W, Colombo T, Steindorfer P. Degree of substitution and volume expanding effect of various medium molecular weight hydroxyethyl starch solutions. Wiener Klinische Wochenschrift. 1994;106:416–421
  88. Chappell D, Jacob M, Hofmann-Kiefer K, et al. Hydrocortisone preserves the vascular barrier by protecting the endothelial glycocalyx. Anesthesiology. 2007;107:776–784
  89. Pries AR, Secomb TW, Gaehtgens P. The endothelial surface layer. Pflügers Archiv. 2000;440:653–666
  90. Rehm M, Zahler S, Lotsch M, et al. Endothelial glycocalyx as an additional barrier determining extravasation of 6% hydroxyethyl starch or 5% albumin solutions in the coronary vascular bed. Anesthesiology. 2004;100:1211–1223
  91. Bruegger D, Jacob M, Rehm M, et al. Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts. American Journal of Physiology. Heart and Circulatory Physiology. 2005;289:H1993–H1999
  92. Jacob M, Bruegger D, Rehm M, et al. The endothelial glycocalyx affords compatibility of Starling‘s principle and high cardiac interstitial albumin levels. Cardiovascular Research. 2007;73:575–586
  93. Vogel J, Sperandio M, Pries AR, et al. Influence of the endothelial glycocalyx on cerebral blood flow in mice. Journal of Cerebral Blood Flow and Metabolism. 2000;20:1571–1578
  94. Vink H, Constantinescu AA, Spaan JA. Oxidized lipoproteins degrade the endothelial surface layer: implications for platelet-endothelial cell adhesion. Circulation. 2000;101:1500–1502
  95. Nieuwdorp M, van Haeften TW, Gouverneur MC, et al. Loss of endothelial glycocalyx during acute hyperglycemia coincides with endothelial dysfunction and coagulation activation in vivo. Diabetes. 2006;55:480–486
  96. Jacob M, Bruegger D, Rehm M, et al. Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability. Anesthesiology. 2006;104:1223–1231
  97. Hu X, Weinbaum S. A new view of Starling's hypothesis at the microstructural level. Microvascular Research. 1999;58:281–304
  98. Hu X, Adamson RH, Liu B, et al. Starling forces that oppose filtration after tissue oncotic pressure is increased. American Journal of Physiology. Heart and Circulatory Physiology. 2000;279:H1724–H1736
  99. Michel CC. Starling: the formulation of his hypothesis of microvascular fluid exchange and its significance after 100 years. Experimental Physiology. 1997;82:1–30
  100. Adamson RH. Permeability of frog mesenteric capillaries after partial pronase digestion of the endothelial glycocalyx. The Journal of Physiology. 1990;428:1–13
  101. Chappell D, Hofmann-Kiefer K, Jacob M, et al. TNF-α induced shedding of the endothelial glycocalyx is prevented by hydrocortisone and antithrombin. Basic Research in Cardiology 2009; 104: 78--89.
  102. Desborough JP. The stress response to trauma and surgery. British Journal of Anaesthesia. 2000;85:109–117
  103. Wilmore DW. Metabolic response to severe surgical illness: overview. World Journal of Surgery. 2000;24:705–711
  104. Kamp-Jensen M, Olesen KL, Bach V, et al. Changes in serum electrolyte and atrial natriuretic peptide concentrations, acid-base and haemodynamic status after rapid infusion of isotonic saline and Ringer lactate solution in healthy volunteers. British Journal of Anaesthesia. 1990;64:606–610
  105. Schutten HJ, Johannessen AC, Torp-Pedersen C, et al. Central venous pressure – a physiological stimulus for secretion of atrial natriuretic peptide in humans?. Acta Physiologica Scandinavica. 1987;131:265–272
  106. Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. The New England Journal of Medicine. 2008;358:125–139
  107. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. The New England Journal of Medicine. 2004;350:2247–2256
  108. Chappell D, Jacob M, Paul O, et al. The glycocalyx of the human umbilical vein endothelial cell. An impressive structure ex vivo but not in culture. Circulation Research. 2009;104:1313–1317

PII: S1521-6896(09)00029-9

doi: 10.1016/j.bpa.2009.05.001

Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 2 , Pages 145-157 , June 2009

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