Key result
Goal-directed therapy optimizes perioperative fluid resuscitation and limits excessive fluid administration, reducing morbidity but with no proven benefit in mortality.
Why the study?
Does goal-directed fluid therapy and the choice of fluid type improve outcomes and reduce complications in perioperative cardiac surgery patients?
Does goal-directed fluid therapy and the choice of fluid type improve outcomes and reduce complications in perioperative cardiac surgery patients?
Goal-directed fluid therapy reduces postoperative morbidity in cardiac surgery patients, while the use of semisynthetic colloids like HES should be avoided due to significant renal toxicity.
May support GDT to reduce morbidity in cardiac surgery without mortality benefit; leaves open optimal fluid selection pending RCTs.
Fluid therapy is a core concept in the management of perioperative patients for maintenance of intravascular volume and organ perfusion. The aim of perioperative fluid therapy is to keep patients at all times in the optimal volume loading, due to both hypovolemia and volume overload may cause organ dysfunction. Intravenous fluid is a drug and because of that, timing and dose is important. 'Liberal' or 'restrictive' strategies and crystalloid or colloid solutions are the unsolved controversies. The term 'restriction' is commonly interpreted to imply hypovolemia, whereas it may simply represent avoidance of the fluid excess seen in the 'liberal' group. The aim of goal-directed fluid therapy is to guide fluid and pharmacological (inotrope) therapy, by using flow-directed hemodynamic parameters, to maintain adequate tissue blood flow, circulating volume, and oxygen delivery. In order to minimize the complications related to fluid administration, preventive strategies and prompt treatments are of utmost importance.
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Dragana Unic‐Stojanovic (2016) conducted a review in Perioperative fluid management. Goal-directed fluid therapy vs. Conventional fluid management was evaluated. Goal-directed therapy optimizes perioperative fluid resuscitation and limits excessive fluid administration, reducing morbidity but with no proven benefit in mortality.
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