Current concepts in fluid therapy and non-invasive haemodynamic monitoring

Marko Žličar

doi:10.22514/sv131.032017.7

Abstract

Advantages of goal directed therapy (GDT) have recently become more and more difficult to prove in the face of newly implemented protocolised patient care approaches that also clearly improve pa-tient outcome. However, individualised approach using GDT has been suggested to be superior to protocolised care and large meta-analyses still consistently show beneficial effects of GDT. Concerns of in-vasiveness were the reason why some pa-tients’ haemodynamics was not measured and in turn were not included in any GDT protocols. Recently, non-invasive devices to measure arterial blood pressure and haemodynamic variables emerged, and al-though they are very appealing and easy to use, they require further validation both by comparison to more invasive methods and by outcome trials.

Highlights

Fluid therapy is an integral part of perioperative management
WHO BENEFITS THE MOST? goal directed therapy (GDT) for guidance of fluid therapy can be applied to many patient populations, but recent evidence suggests that some subgroups may benefit more than others
Since the actual purpose of monitors is to guide therapy, studies are needed to determine if a non-invasive haemodynamic monitor coupled with an interventional protocol effects patients’ outcome

Summary

Introduction

Fluid therapy is an integral part of perioperative management. Often more attention is given to administered drugs, and very little to choice and rate of administration of fluids. There is a lot of interest in cardiac output guided fluid therapy and haemodynamic monitoring. Following is a discussion on current concepts in fluid therapy, haemodynamic monitoring and newer non-invasive devices.

Results

Conclusion