Targeted fluid administration for major surgery

Abstract

Summary Targeted Fluid Adminstration (TFA) is a technique using less invasive cardiac output monitors to guide individualised intra-operative fluid therapy. Typically, the anaesthetist administers boluses of approximately 200–250 ml of colloid solution whilst measuring changes in stroke volume or another measure of fluid responsiveness, such as stroke volume variation. When the stroke volume measurements indicate that the cardiovascular system is no longer fluid responsive, the patient is assumed to be close to the upper flat phase of the Frank–Starling Curve. Research using TFA suggests that post-operative complications such as ileus and length of hospital stay are reduced when fluid therapy is managed in this way. Most of the positive evidence for TFA has been achieved using the oesophageal Doppler (CardioQ, Deltex Medical, Chichester UK), although other cardiac output monitors are available, there are few clinical outcome studies that justify their use in routine practice. Widespread adoption of TFA for patients undergoing major surgery will help achieve the goals of enhanced recovery.