Questions · Intraoperative Fluid Strategy
8 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
Within an enhanced recovery pathway, state the intraoperative volume status you should aim for, how the fluid plan should be chosen, and the two outcomes this approach is intended to improve.
Answer: Aim for euvolemia using an individualized goal-directed therapy plan based on patient and surgical risk, matching the monitoring to the hemodynamic goals. The stated aims are to reduce complications and length of stay.
Euvolemia is the target, and the monitoring you pick should match the haemodynamic goals for that patient and that operation.
Source claim: 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.
Current Concepts of Fluid Management in Enhanced Recovery Pathways, British journal of anaesthesia 2018
recall · CA-1 · phrased by llm
During goal-directed fluid therapy guided by stroke volume, what proportion of fluid boluses in a retrospective haemodynamic analysis actually raised stroke volume by 10%, and what two measured conditions identified boluses with essentially no chance of working?
Answer: Only 44% of boluses raised stroke volume by 10%. The chance fell to near zero when stroke volume already exceeded 100 mL and had dropped less than 8% since the last optimisation.
More than half the boluses in that analysis did nothing to stroke volume - a high stroke volume that has barely fallen is a signal to stop giving fluid.
Source claim: 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.
Predicting Fluid Responsiveness Using Esophagus Doppler Monitoring and Pulse Oximetry Derived Pleth Variability Index; Retrospective Analysis of a Hemodynamic Study, Acta anaesthesiologica Scandinavica 2023
recall · CA-2 · phrased by llm
In a multicentre randomised controlled trial of transthoracic oesophagectomy, goal-directed therapy was titrated to one specific haemodynamic variable. State the target used and the effect on the trial's composite outcome, giving both event rates.
Answer: The target was stroke volume variation below 8%. Death or major complications fell from 35% to 19%.
That 35% to 19% difference belongs to transthoracic oesophagectomy with a stroke volume variation target below 8% - that is the setting in which it was shown.
Source claim: In transthoracic oesophagectomy, goal-directed therapy targeting stroke volume variation below 8% reduced death or major complications from 35% to 19%.
Impact of Intraoperative Goal-Directed Fluid Therapy on Major Morbidity and Mortality After Transthoracic Oesophagectomy: A Multicentre, Randomised Controlled Trial, British journal of anaesthesia 2020
recall · CA-2 · phrased by llm
A meta-analysis of 95 trials of goal-directed therapy reports a mortality odds ratio of 0.66 along with reductions in pneumonia, kidney injury and wound infection. A resident asks whether this means running fluid by a stroke-volume protocol saves lives. Answer using what the subgroup analysis of that same meta-analysis showed.
Answer: No. The overall pooled result was reduced mortality (odds ratio 0.66) and less pneumonia, kidney injury and wound infection, but subgroup analysis found no mortality benefit for fluid-only protocols, so the mortality signal did not hold for fluid alone.
The headline mortality odds ratio came from goal-directed therapy as a whole; the fluid-only subgroup showed no mortality benefit.
Source claim: 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.
Does Goal-Directed Haemodynamic and Fluid Therapy Improve Peri-Operative Outcomes?: A Systematic Review and Meta-Analysis, European journal of anaesthesiology 2018
recall · CA-3 · phrased by llm
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.