Intraoperative Fluid Strategy
CA-2 · I.B.5.e I.B.1.d.5 I.D.2.d.2
44Sources
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Goal-directed haemodynamic therapy is not recommended routinely for major elective abdominal surgery; consider it patient by patient in moderate- to high-risk major noncardiac surgery, and do not use fixed low-dose inotrope infusions as part of the protocol.
PMID 40640043
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Only 44% of boluses given during goal-directed fluid therapy actually raised stroke volume by 10%, and the chance fell to near zero when stroke volume already exceeded 100 mL and had dropped less than 8% since the last optimisation.
PMID 37140405
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Across 95 trials, goal-directed therapy reduced mortality (odds ratio 0.66) and pneumonia, kidney injury and wound infection — but subgroup analysis found no mortality benefit for fluid-only protocols.
PMID 29369117
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In transthoracic oesophagectomy, goal-directed therapy targeting stroke volume variation below 8% reduced death or major complications from 35% to 19%.
PMID 33092805
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Intraoperatively, maintain euvolemia using an individualized goal-directed therapy plan based on patient and surgical risk, matching monitoring needs with hemodynamic goals to reduce complications and length of stay.
PMID 29406186
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Goal-directed therapy reduced overall postoperative complications regardless of the total volume infused, but did not reduce perioperative mortality or any single organ-specific complication.
PMID 33522953
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