Perioperative goal-directed therapy - What is the evidence?

Abstract

Perioperative goal-directed therapy aims at optimizing global hemodynamics during the perioperative period by titrating fluids, vasopressors, and/or inotropes to predefined hemodynamic goals. There is evidence on the benefit of perioperative goal-directed therapy, but its adoption into clinical practice is slow and incomprehensive. Current evidence indicates that treating patients according to perioperative goal-directed therapy protocols reduces morbidity and mortality, particularly in patients having high-risk surgery. Perioperative goal-directed therapy protocols need to be started early, should include vasoactive agents in addition to fluids, and should target blood flow related variables. Future promising developments in the field of perioperative goal-directed therapy include personalized hemodynamic management and closed-loop system management.

Keywords: cardiac output; cardiovascular dynamics; hemodynamic monitoring; pulse pressure variation; stroke volume variation.