Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy

Mark R Edwards¹, Gudrun Kunst², Lui G Forni³, Desirée Chappell⁴, Timothy E Miller⁵; PeriOperative Quality Initiative 11 (POQI-11) Group Members

Collaborators, Affiliations

Collaborators

PeriOperative Quality Initiative 11 (POQI-11) Group Members:
Georg Auzinger⁶, Desirée Chappell⁴, Tong J Gan⁷, Mark R Edwards⁸, Nick Fletcher⁹, Lui G Forni¹⁰, Michael P W Grocott¹¹, Gudrun Kunst¹², Timothy E Miller⁵, Vicki Morton-Bailey¹³, Paul S Myles¹⁴, Marlies Ostermann¹⁵, Jacob Raphael¹⁶, Bernd Saugel¹⁷, Daniel I Sessler¹⁸, Andrew D Shaw¹⁹, Alexander Zarbock²⁰

Affiliations

¹ Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK. Electronic address: mark.edwards2@uhs.nhs.uk.
² Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust and School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, UK.
³ Department of Clinical & Experimental Medicine, Royal Surrey County Hospital NHS Foundation Trust, School of Medicine, University of Surrey, UK.
⁴ NorthStar Anesthesia, Irving, TX, USA.
⁵ Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.
⁶ Critical Care, Cleveland Clinic London, London, UK; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; King's College London, London, UK.
⁷ Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Perioperative & Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.
⁹ Cleveland Clinic Lerner College of Medicine, Cleveland Clinic London, London, UK.
¹⁰ Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, School of Medicine, University of Surrey, Surrey, UK.
¹¹ Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.
¹² Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust and School of Cardiovascular and Metabolic Medicine & Sciences, King's College London London, UK.
¹³ Providence Anesthesiology Associates, Charlotte, NC, USA.
¹⁴ Alfred Hospital and Monash University, Melbourne, VIC, Australia.
¹⁵ Department of Critical Care, King's College London, Guy's & St Thomas Hospital, London, UK.
¹⁶ Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
¹⁷ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
¹⁹ Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA.
²⁰ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.

PMID: 40640043
DOI: 10.1016/j.bja.2025.05.033

Review

Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy

Mark R Edwards et al. Br J Anaesth. 2025 Sep.

. 2025 Sep;135(3):547-560.

doi: 10.1016/j.bja.2025.05.033. Epub 2025 Jul 10.

Authors

Mark R Edwards¹, Gudrun Kunst², Lui G Forni³, Desirée Chappell⁴, Timothy E Miller⁵; PeriOperative Quality Initiative 11 (POQI-11) Group Members

Collaborators

PeriOperative Quality Initiative 11 (POQI-11) Group Members:
Georg Auzinger⁶, Desirée Chappell⁴, Tong J Gan⁷, Mark R Edwards⁸, Nick Fletcher⁹, Lui G Forni¹⁰, Michael P W Grocott¹¹, Gudrun Kunst¹², Timothy E Miller⁵, Vicki Morton-Bailey¹³, Paul S Myles¹⁴, Marlies Ostermann¹⁵, Jacob Raphael¹⁶, Bernd Saugel¹⁷, Daniel I Sessler¹⁸, Andrew D Shaw¹⁹, Alexander Zarbock²⁰

Affiliations

¹ Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK. Electronic address: mark.edwards2@uhs.nhs.uk.
² Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust and School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, UK.
³ Department of Clinical & Experimental Medicine, Royal Surrey County Hospital NHS Foundation Trust, School of Medicine, University of Surrey, UK.
⁴ NorthStar Anesthesia, Irving, TX, USA.
⁵ Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA.
⁶ Critical Care, Cleveland Clinic London, London, UK; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; King's College London, London, UK.
⁷ Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Perioperative & Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.
⁹ Cleveland Clinic Lerner College of Medicine, Cleveland Clinic London, London, UK.
¹⁰ Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, School of Medicine, University of Surrey, Surrey, UK.
¹¹ Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.
¹² Department of Anaesthetics and Pain Therapy, King's College Hospital NHS Foundation Trust and School of Cardiovascular and Metabolic Medicine & Sciences, King's College London London, UK.
¹³ Providence Anesthesiology Associates, Charlotte, NC, USA.
¹⁴ Alfred Hospital and Monash University, Melbourne, VIC, Australia.
¹⁵ Department of Critical Care, King's College London, Guy's & St Thomas Hospital, London, UK.
¹⁶ Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
¹⁷ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
¹⁹ Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA.
²⁰ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.

PMID: 40640043
DOI: 10.1016/j.bja.2025.05.033

Abstract

Perioperative goal-directed haemodynamic therapy (GDHT) includes a variety of protocolised approaches to the assessment and management of the circulatory system and blood flow for patients undergoing surgery. Here we present updated consensus statements on perioperative GDHT developed during the 11th Perioperative Quality Initiative (POQI) consensus conference meeting held in London, UK in June, 2023. Statements relating to the definitions, components, and underlying physiology surrounding GDHT are proposed. We recommend considering use of GDHT in specific settings including during cardiopulmonary bypass (CPB), after cardiac surgery, and during hip fracture surgery. However, the level of evidence is weak in these settings. Clinicians can consider use of GDHT protocols on an individual patient basis for moderate- to high-risk patients undergoing major noncardiac surgery; however, we recommend against use of fixed low-dose inotrope infusions as part of GDHT protocols. We do not recommend routine use of GDHT protocols for patients undergoing major elective abdominal surgery. There is currently insufficient evidence to recommend routine use of GDHT during emergency abdominal surgery. Future research should focus on individualisation of GDHT to individual patients' haemodynamic requirements, newer paradigms such as technology-assisted delivery of GDHT protocols, and the role of predictive models using artificial intelligence.

Keywords: cardiac output; fluid therapy; goal-directed haemodynamic therapy; inotropes; perioperative blood pressure.

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Conflict of interest statement

Declarations of interest Members of the 11th POQI meeting: MO has received research funding from Baxter Healthcare (Deerfield, IL, USA), Biomerieux (Marcy-l'Étoile, France), and LaJolla Pharma (San Diego, CA, USA). JR has received consulting fees from Octapharma (Lachen, Switzerland) and Avania Medical (Bilthoven, Netherlands). AZ has received consulting fees from Biomerieux, Baxter, Bayer (Leverkusen, Germany), Novartis (Basel, Switzerland), Guard Therapeutics (Stockholm, Sweden), AM Pharma (Utrecht, Netherlands), Paion (Aachen, Germany), Fresenius Kabi (Bad Homburg, Germany), research funding from Biomerieux, Fresenius, Baxter, and speakers fees from Biomerieux, Fresenius, and Baxter. ADS has served as a consultant for Novartis, Alexion (Boston, MA, USA), AM Pharma, Renibus (Southlake, TX, USA), and Retia Medical (White Plains, NY, USA). TJG has received honoraria from Edwards Lifesciences (Irvine, CA, USA), Medtronic (Minneapolis, MN, USA) and Merck (Rahway, NJ, USA). MRE has received an honorarium for lecturing for Edwards Lifesciences and grant funding from the UK National Institute for Health and Care Research (NIHR, UK). NF is a consultant for Edwards Lifesciences. LGF has received research support from Baxter Healthcare, Ortho Clinical Diagnostics (Raritan, NJ, USA), and Sphingotec (Hennigsdorf, Germany), and honoraria from Baxter Healthcare, Fresenius, Sphingotec, and Exthera Medical (Martinez, CA, USA). GK has received honoraria and travel expenses from Edwards Lifesciences. TEM is a consultant for Philips (Cambridge, MA, USA) and Retia Medical. VMB has received honoraria from Edwards Lifesciences. JR received consulting fees from Octapharma. BS has received research grants and honoraria from Edwards Lifesciences, Baxter Healthcare, GE Healthcare (Chicago, IL, USA), CNSystems Medizintechnik (Graz, Austria), Pulsion Medical Systems (Feldkirchen, Germany), Vygon (Aachen, Germany), Retia Medical, Osypka Medical (Berlin, Germany) and has received honoraria from Philips North America (Cambridge, MA, USA), Philips Medizin Systeme Böblingen (Böblingen, Germany), Maquet Critical Care (Solna, Sweden), Getinge (Gothenburg, Sweden), Masimo (Neuchâtel, Switzerland), Dynocardia (Cambridge, MA, USA), Ratiopharm (Ulm, Germany), and Tensys Medical (San Diego, CA, USA). BS is an editor of the British Journal of Anaesthesia. DIS has received research funding from Edwards Lifesciences and is an advisor and has equity interest in Perceptive Medical (Newport Beach, CA, USA). MPWG has received unrestricted grant funding and served as a consultant for Edwards Lifesciences; has served as a consultant for Sphere Medical (London, UK) and SouthWestSensor (Southampton, UK); has received unrestricted research funding from Pharmacosmos (Holbaek, Denmark); and is in part funded by the UK NIHR Senior Investigator Scheme and in part by the NIHR Southampton Biomedical Research Centre. PSM is supported by an Australian National Health and Medical Research Council (Canberra, Australia) Investigator Grant. GA and DC declare that they have no conflicts of interest.

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Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy

Collaborators

Affiliations

Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

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