Abstract
The literature concerning the use of goal directed haemodynamic therapy (GDHT) in high risk surgical patients has been importantly increased by the study of Lopes and colleagues. Using a minimally invasive assessment of fluid status and pulse pressure variation monitoring during mechanical ventilation, improvements were seen in post-operative complications, duration of mechanical ventilation, and length of hospital and intensive care unit (ICU) stay. Many small studies have shown improved outcome using various GDHT techniques but widespread implementation has not occurred. Those caring for perioperative patients need to accept the published evidence base or undertake a larger, multi-centre study.
Highlights
Lopes and colleagues [1] add to the list of studies investigating the concept of goal directed haemodynamic therapy (GDHT)
We have worked through pulmonary artery catheters, Doppler probes, and less invasive methods of cardiac output measurement, but the recent paper is the first to use a truly minimally invasive technique to assess the requirement for further fluid infusions above normal perioperative care
In their study of goal directed fluid management based on pulse pressure variation monitoring during high risk surgery, they demonstrate a spectacular improvement in outcome using their monitoring and fluid management strategy
Summary
Lopes and colleagues [1] add to the list of studies investigating the concept of goal directed haemodynamic therapy (GDHT). GDHT in high risk surgical patients has been investigated for over 20 years [2].
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