Third room

This article deals with the third room in terms of infusion therapy; for the band see The Third Room

In infusion therapy, a hypothetical space in the body is described as the third space , which is intended to explain blood plasma losses during major operations. There is no uniform definition.

During major operations , especially abdominal surgery , patients often have an inexplicable loss of volume that has to be replaced by infusion solutions in order to keep the circulation stable. This is a shift in the body that can be detected as weight gain due to the additional amount of infusion, which in adults can be several kilograms. In the past, the concept of a shift to the third room was postulated to explain this fluid requirement despite a positive balance .

Up to now, this third room could neither be reliably quantified nor localized. The urine-producing system, the liquor space , secretions in the gastrointestinal tract , peritoneum ( ascites ) and the eye chamber (increase in transcellular fluid ) have been suggested as possible anatomical secretion spaces . Edema of the connective tissue (interstitial) is described as a so-called non-anatomical part . For this, a separation from the functional extracellular space , i.e. the extracellular space participating in fluid exchange, is postulated.

On the basis of the current data situation, it must most likely be assumed that a third room in the sense of infusion therapy does not exist. The fluid rearrangement is probably a shift from the vascular system (intravascular compartment, intravascular space) into the connective tissue (interstitial compartment, extravascular space), i.e. within the extracellular space . This is possibly due to damage to the glycocalyx of the vessel walls, a barrier consisting of carbohydrates and proteins that is attached to the endothelium .

Individual evidence

1. ↑ ^{a b c} M. Jacob, D. Chappell: Myths and facts of perioperative infusion therapy. In: Anaesthesiology and Intensive Care Medicine. 6, 2009, pp. 358-376.
2. ^ B. Brandstrup: Fluid therapy for the surgical patient. In: Best Pract Res Clin Anaesthesiol. 20 (2), Jun 2006, pp. 265-283. Review. PMID 16850777

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