Fluid - Matters|Part 1 Definite definitions, fluid physiology

Names, titles and definitions were sliced, diced and discussed at the Perioperative Quality Initiative (POQI). This conversation, recorded on the morning of the second day of the meeting and featuring some of the participants, reflects that. "Stress volumes" and "Pre-load" are a couple of examples given in this piece. Everyone involved knew what these words described but once discussions got into detail it became clear multiple definitions were at play. Part of the point of an initiative like POQI is to bring terms like this, used by different people in different ways, to a concensus. This conversation explores some of the dillemmas which emerged as a result. 'Starling pressures' are discussed as is the role of lymph in the fluid balance of our patient's bodies. Furthermore the topic of fluid responsiveness comes up as does passive leg raising. Also, how does the fact that a patient's blood pressure can be normal, even if they've lost upto 25% of blood volume, impact on our understanding of these things? Finally, how does this relate to the practitioners at the bedside? How do we translate these debates into practical advice which will make a real difference to patients, this piece goes some way towards answering those questions. Send us your thoughts and contribute ot the debate: [email protected] Coming from this summer's Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham this podcast is presented by Desiree Chappell with Professor Monty Mythen, Henry Howe and their guest Tim Miller, anaesthsiologist from Duke University Medical Centre and organiser of the POQI meeting.