Impact of goal-directed perioperative fluid management in high-risk surgical procedures: a literature review

Abstract

Guidelines for the perioperative administration of fluid are often based on static hemodynamic targets such as central venous pressure, and delayed volume status indexes such as blood pressure, heart rate, capillary refill, and urine output. Traditional fluid management protocols also rely heavily on algorithmic estimates of fluid deficit, intravascular fluid volume status, fluid loss, and basal fluid requirements to guide perioperative fluid administration. Such formulaic approaches lack definitive physiologic endpoints for determining fluid optimization and fail to address the roles of tissue oxygenation and end-organ perfusion in achieving positive long-term patient outcomes. Recent advances in hemodynamic monitoring have produced sophisticated dynamic measures of volume status, such as stroke volume variation and pulse pressure variation, which may serve as functional indexes for perioperative fluid administration. This article reviews randomized controlled trials measuring the impact of perioperative goal-directed therapy on outcomes among patients undergoing high-risk surgical procedures. A broad literature search was conducted, and 12 studies met the inclusion criteria. Studies were evaluated for design, population, goal-directed therapy targets, monitoring devices used, clinical endpoints, methods, and results. Goal-directed therapy was associated with decreased hospital stay compared with the control group (in 7 studies) and reduced number of postoperative complications (7 studies).