Goal-Directed Intraoperative Therapy Reduces Morbidity and Length of Hospital Stay in High-Risk Surgical Patients

Simplified Intraoperative Goal-Directed Therapy Using the FloTrac/Vigileo System: An Analysis of Its Usefulness and Safety

“…The intraoperative execution of standardized hemodynamic management based on a predefined algorithm prevents hypoperfusion and an excess of fluid administration, and improves patient outcomes. It has been suggested that outcomes are improved, especially in patients with a systemic comorbidity [3]. Fluid loading based on the varied experiences of anesthesiologists may lead to excessive loading of sodium ions or fluid.…”

Inter-device differences in monitoring for goal-directed fluid therapy

“…103 A small randomized controlled trial in patients undergoing major abdominal surgery found that titration of oxygen extraction ratio (O 2 ER; based on ScvO 2 ) to \ 27% reduced LOS and organ failure. 104 Importantly, the O 2 ER group had lower lactates and higher ScvO 2 than the control group at the majority of time points, showing physiologic efficacy. A subsequent larger randomized controlled trial focusing on maintenance of SvO 2 [ 70% (and lactate \ 2 mEqÁL -1 in cardiac surgical patients led to a slight reduction in morbidity and LOS, although SvO 2 and lactate did not appear to be appreciably different between groups, making the result difficult to interpret.…”

“…111 While there was not a significant difference in the incidence of stroke (the study was not powered to detect this), use of cerebral oximetry led to a reduction in a composite index of overall morbidity. The reasons for this are complex but likely reflect the ability of the brain to autoregulate during cardiopulmonary bypass, 112,113 its position as a sentinel organ, 114 as well as the benefits of protocolized oxygen-centric hemodynamic management in terms of organ function, which has been shown in medical 102 as well as both non-cardiac 104 and cardiac 105 surgical patient populations (although it is important to point out that not all studies have been positive). 103 Given the brain's ability to autoregulate, one would expect it to be highly specific but insensitive for perfusion abnormalities; thus, investigators have sought other organ systems to serve as a more sensitive sign of malperfusion or impending organ injury.…”

Cardiovascular Monitoring and Substitution of the Blood Volume During Liver Transplantation

“…volume is administrated until cardiac function does not depend on preload to the heart. This volume administration strategy is of interest not only because it remains elusive what volume rate a fixed volume administration strategy should aim at , but also because an individualized fluid administration strategy, in contrast to a fixed volume strategy, consistently improves outcome for surgical patients (BundgaardNielsen et al, 2007a;Lopes et al, 2007;Donati et al, 2007;Abbas & Hill, 2008;Mayer et al, 2010). Based on administration of a crystalloid or a colloid, an inherent difficulty for individualized goal directed fluid therapy is, however, that a reduction in haematocrit is associated with an increase in CO, i.e.…”