Goal-directed therapy in intraoperative fluid and hemodynamic management

Maria Cristina Gutierrez, Peter G Moore, Hong Liu, Maria Cristina Gutierrez, Peter G Moore, Hong Liu

Abstract

Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk procedures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.

Keywords: fluid; goal-directed therapy; hemodynamic; high-risk surgery; monitoring.

Conflict of interest statement

The authors reported no conflict of interests.

Figures

Fig 1.. Transesophageal echocardiography image of a…
Fig 1.. Transesophageal echocardiography image of a left ventricular (LV) transgastric short axis view.
The diastolic area is corresponding to the LV preload. AL: ante lateral papillary muscle; PM: postal medial papillary muscle.
Fig 2.. A schematic drawing of Frank-Starling…
Fig 2.. A schematic drawing of Frank-Starling curve.
The y-axis represents the cardiac output and the x-axis represents the left ventricular (LV) preload. The arrow indicates the turning point where the cardiac output decreases with increased LV preload.
Fig 3.. A sample algorithm to guide…
Fig 3.. A sample algorithm to guide intraoperative hemodynamic management using blood pressure (BP), cardiac output (CO) and stoke volume variation (SVV) as the parameters.

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