Perioperative fluid management-Goal Directed Therapy (GDT)

Perioperative goal-directed hemodynamic therapy is a protocolized treatment strategy aimed at optimization of global cardiovascular dynamics, including oxygen delivery to tissues and organ perfusion pressure. This is achieved by titrating fluids, vasopressors, and inotropes to predefined physiological target values of hemodynamic variables. Its scope is to reduce complications (acute kidney disease, pulmonary oedema, respiratory distress syndrome, wound infections), decrease major abdominal and systemic postoperative complications, length of stay and postoperative morbidity and mortality mainly in high-risk patients undergoing major surgery. Identifying patients in whom perioperative goal-directed hemodynamic therapy can actually improve postoperative outcomes is crucial. This is a review focusing on all the aspects of GDFT compared to standard fluid therapy during surgery.

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Goal-Directed Therapy of Perioperative Fluid Management within Enhanced Recovery after Surgery

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA ◽

10.2199/jjsca.37.219 ◽

2017 ◽

Vol 37 (2) ◽

pp. 219-224

Author(s):

Takashi MATSUSAKI ◽

Hiroshi MORIMATSU

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Fluid Management ◽

Goal Directed Therapy ◽

Perioperative Fluid Management

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Renal protection in cardiovascular surgery

F1000Research ◽

10.12688/f1000research.7348.1 ◽

2016 ◽

Vol 5 ◽

pp. 331 ◽

Cited By ~ 3

Author(s):

Nora Di Tomasso ◽

Fabrizio Monaco ◽

Giovanni Landoni

Keyword(s):

At Risk ◽

Renal Damage ◽

Scientific Evidence ◽

Fluid Management ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Major Surgery ◽

Renal Protection ◽

Patients At Risk ◽

Risk Patients

Acute kidney injury (AKI) is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e.g. hemodynamic stability, fluid management, and avoidance of further damage); therefore, the management of patients at risk of AKI should aim at prevention of renal damage. Thus, the present narrative review analyzes the pathophysiology underlying AKI (specifically in high-risk patients), the preoperative risk factors that predispose to renal damage, early biomarkers related to AKI, and the strategies employed for perioperative renal protection. The most recent scientific evidence has been considered, and whenever conflicting data were encountered possible suggestions are provided.

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Perioperative Fluid Management Strategies in Major Surgery

Survey of Anesthesiology ◽

10.1097/01.sa.0000433314.85404.85 ◽

2013 ◽

Vol 57 (5) ◽

pp. 265-266 ◽

Cited By ~ 1

Author(s):

Tomas Corcoran ◽

Julia Emma Joy Rhodes ◽

Sarah Clarke ◽

Paul S. Myles ◽

Kwok M. Ho

Keyword(s):

Fluid Management ◽

Management Strategies ◽

Major Surgery ◽

Perioperative Fluid Management

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Perioperative Fluid Management Strategies in Major Surgery

Anesthesia & Analgesia ◽

10.1213/ane.0b013e318240d6eb ◽

2012 ◽

Vol 114 (3) ◽

pp. 640-651 ◽

Cited By ~ 275

Author(s):

Tomas Corcoran ◽

Julia Emma Joy Rhodes ◽

Sarah Clarke ◽

Paul S. Myles ◽

Kwok M. Ho

Keyword(s):

Fluid Management ◽

Management Strategies ◽

Major Surgery ◽

Perioperative Fluid Management

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Faculty Opinions recommendation of A rational approach to perioperative fluid management.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1126766.630683 ◽

2009 ◽

Author(s):

Philippe Van der Linden ◽

Robert Tircoveanu

Keyword(s):

Fluid Management ◽

Rational Approach ◽

Perioperative Fluid Management

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Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

Critical Care ◽

10.1186/s13054-021-03629-y ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Antonio Messina ◽

Chiara Robba ◽

Lorenzo Calabrò ◽

Daniel Zambelli ◽

Francesca Iannuzzi ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Randomised Controlled Trials ◽

Elective Surgery ◽

Fluid Management ◽

Risk Difference ◽

Controlled Trials ◽

Perioperative Fluid Management ◽

Liberal Approach ◽

Randomised Controlled

Abstract Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value = 0.001]. We found no difference in either early (p value = 0.33) or late (p value = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059.

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