This editorial debates the balance of evidence of fluid management in perioperative care.
“We believe that goal-directed therapy has the potential to reduce length of stay in the hospital and decrease post-operative complications in patients undergoing major and high-risk surgery. In fact, recent studies using goal-directed therapy in an ERAS setting have demonstrated a reduction in length of stay and complications.”
This editorial examines how perioperative fluid management influences patients’ outcomes. The authors describe the high inter and intraprovider variability. They consider the role of different methodologies in fluid volume and management in different patient risk profiles.
“We should encourage institutions that do not have an ERAS program in place to apply goal-directed strategies, because the current evidence supports patient benefit.”
Cannesson M, Gan TJ. PRO: Perioperative Goal-Directed Fluid Therapy is an essential element of an Enhanced Recovery Protocol. Anesth Analg. 2016;122(5):1258-60.
“The whole philosophy of goal-directed therapy is that if one wants to improve hemodynamics, then give fluid whenever the patient is a responder to fluid. When the patient is not a responder to fluid and if the arterial blood pressure is still is still low, consider vasopressors instead.”