Abstract
BackgroundGoal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery. However, there has been no assessment regarding its use in clinical practice.MethodsAn electronic survey was administered to randomly selected anaesthetists from the United Kingdom (UK, n = 2000) and the United States of America (USA, n = 2000), and 500 anaesthetists from Australia/New Zealand (AUS/NZ). Preferences, clinical use and attitudes towards GDFT were investigated. Results were collated to examine regional differences.ResultsThe response rates from the UK (n = 708) and AUS/NZ (n = 180) were 35%, and 36% respectively. The response rate from the USA was very low (n = 178; 9%). GDFT use was significantly more common in the UK than in AUS/NZ (p < 0.01). The Oesophageal Doppler Monitor was the most preferred instrument in the UK (n = 362; h76%) with no clear preferences in other regions. GDFT was most commonly utilised in major abdominal surgery and for patients with significant comorbidities. The commonest reasons stated for not using GDFT were either lack of availability of monitoring tools (AUS/NZ: 57 (70%); UK: 94 (64%)) or a lack of experience with instruments (AUS/NZ: 43 (53%); UK: 51 (35%)). A subset of respondents (AUS/NZ: 22(27%); UK: 45 (30%)) felt GDFT provided no perceived benefit. Enthusiasm towards the use of GDFT in the absence of existing barriers was high.ConclusionSeveral hypotheses were generated regarding important differences in the use of GDFT between anaesthetists from the UK and AUS/NZ. There is significant interest in utilising GDFT in clinical practice and existing barriers should be addressed.
Highlights
Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery
This concept is known as goal–directed fluid therapy (GDFT)
GDFT therapy primarily involves the administration of intravenous fluids to optimise pre-defined, patient-specific clinical proxies of tissue perfusion [7]
Summary
Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery. There has been a renewed emphasis on research investigating perioperative fluid therapy [1,2] This has been complemented by a surge in research exploring optimised perioperative care [3,4,5]. An increasing body of work has highlighted the importance of physiologically-guided, individualised fluid administration in keeping with the broad principles recommended by Moore and Shires over 40 years ago [6,7]. This concept is known as goal–directed fluid therapy (GDFT). GDFT therapy primarily involves the administration of intravenous fluids to optimise pre-defined, patient-specific clinical proxies of tissue perfusion [7].
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