Goal-directed Perioperative Fluid Management: Why, When, and How?

Section of Surgical Pathophysiology 4074, Rigshospitalet Copenhagen University, Copenhagen, Denmark. .
Anesthesiology (Impact Factor: 5.88). 03/2009; 110(3):453-5. DOI: 10.1097/ALN.0b013e3181984217
Source: PubMed
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    • "This may also influence postoperative fluid requirements [13]. Important shortcomings of the evidence base governing goal-directed fluid therapy in major colorectal surgery have also been previously described and as a result, further procedure-specific studies have been thought to be necessary [13] [14]. Thus, we conducted a study to examine the influence of goal-directed fluid therapy on clinical outcomes-with total complications as the primary focus-after elective rectal surgery. "
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    ABSTRACT: Introduction: Goal-Directed Fluid Therapy (GDFT) has been previously shown to decrease complications and hospital length of stay in major colorectal surgery but the data are not specific to rectal surgery and may be potentially outdated. This study investigated whether GDFT provides clinical benefits in patients undergoing major elective rectal surgery. Methods: There were 81 consecutive patients in this cohort study. Twenty-seven patients were allotted to GDFT using the Oesophageal Doppler Monitor (ODM) and received boluses of colloid fluid based on corrected flow time and stroke volume. These patients were compared with a historical cohort of the previous 54 patients managed without the ODM. The primary endpoint of the study was 30-day total complications which were defined and graded. Secondary endpoints included hospital length of stay (LOS) and fluid volumes administered. Results: There were no differences at baseline between the two groups. Patients in the treatment group received a higher volume of colloid fluids (1000 mL vs. 500 mL; p < 0.01) but there were no differences in overall fluid volumes administered intraoperatively (3000 mL vs. 3000 mL; p = 0.41). A non-significant trend (p = 0.06) suggested that patients allotted to GDFT had decreased fluid requirement in the first 24 h after surgery. There were no differences in median total fluid volumes (12700 mL vs. 10407 mL; p = 0.95), total complications (22 [81%] vs. 44 [81%]; p = 1.00) or median hospital LOS (9 days vs. 10 days; p = 0.92) between the two groups. Conclusion: Intraoperative GDFT did not improve clinical outcomes following major elective rectal surgery. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
    International Journal of Surgery (London, England) 11/2014; 12(12):1467-1472. DOI:10.1016/j.ijsu.2014.11.010 · 1.53 Impact Factor
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    • "A proportion of people from all the regions surveyed remain sceptical regarding the proposed benefits of GDFT. To an extent, this is justified as important questions remain unanswered, such as efficacy in settings where fluid restriction has been shown to be beneficial [21-23]. Nonetheless, it is interesting to note that in the absence of barriers, a high proportion of respondents would be willing to consider GDFT into their practice. "
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    ABSTRACT: Background Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery. However, there has been no assessment regarding its use in clinical practice. Methods An electronic survey was administered to randomly selected anaesthetists from the United Kingdom (UK, n = 2000) and the United States of America (USA, n = 2000), and 500 anaesthetists from Australia/New Zealand (AUS/NZ). Preferences, clinical use and attitudes towards GDFT were investigated. Results were collated to examine regional differences. Results The response rates from the UK (n = 708) and AUS/NZ (n = 180) were 35%, and 36% respectively. The response rate from the USA was very low (n = 178; 9%). GDFT use was significantly more common in the UK than in AUS/NZ (p < 0.01). The Oesophageal Doppler Monitor was the most preferred instrument in the UK (n = 362; h76%) with no clear preferences in other regions. GDFT was most commonly utilised in major abdominal surgery and for patients with significant comorbidities. The commonest reasons stated for not using GDFT were either lack of availability of monitoring tools (AUS/NZ: 57 (70%); UK: 94 (64%)) or a lack of experience with instruments (AUS/NZ: 43 (53%); UK: 51 (35%)). A subset of respondents (AUS/NZ: 22(27%); UK: 45 (30%)) felt GDFT provided no perceived benefit. Enthusiasm towards the use of GDFT in the absence of existing barriers was high. Conclusion Several hypotheses were generated regarding important differences in the use of GDFT between anaesthetists from the UK and AUS/NZ. There is significant interest in utilising GDFT in clinical practice and existing barriers should be addressed.
    BMC Anesthesiology 02/2013; 13(1):5. DOI:10.1186/1471-2253-13-5 · 1.38 Impact Factor
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    ABSTRACT: Aktuelle Ergebnisse haben gezeigt, dass durch die multimodale Kombination einzelner evidenzbasierter Therapiemaßnahmen (Fast-Track-Methode) eine Verbesserung der postoperativen Regenerationsphase mit Absenkung der Morbidität, reduzierter stationärer Verweildauer und schnellerer Rekonvaleszenz erzielt wird. Trotz damit einhergehender positiver ökonomischer Effekte hat sich die Fast-Track-Chirurgie bisher nur relativ langsam etabliert. Eine weitere Verbesserung des postoperativen Outcomes kann durch die Weiterentwicklung der einzelnen Therapiemaßnahmen erreicht werden, wobei der Fokus insbesondere auf der minimal-invasiven Chirurgie, effektiver multimodaler nichtopioider Analgesie und pharmakologischer Stressreduktion liegen sollte.
    Der Chirurg 01/2009; 80(8). · 0.57 Impact Factor
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