GOAL-DIRECTED FLUID THERAPY IN MAJOR THORACO-ABDOMINAL SURGERY
Abstract
Goal-directed fluid therapy (GDFT) in the thoracic-abdominal surgery has proven to be very challenging for many years. Minimal-invasive hemodynamic monitoring has become the standard at the Enhanced recovery after surgery – ERAS protocols. Additionally, established protocols in anesthetic management for major surgery recommend goal-directed fluid therapy. However, the use of GDFT remains controversial in certain surgical operations due to specific conditions (pneumoperitoneum or caponothorax in endoscopic procedures, open chest, protective mechanical ventilation in one lung ventilation). The modern advanced hemodynamic monitoring is less invasive and provides numerous hemodynamic variables for simple interpretation. Numerous studies have demonstrated the use of goal-directed therapy in intraoperative fluid replacement and its beneficial effects on lower postoperative morbidity and treatment costs. Using available literature performed different medical search strategies, the present review shows potential solutions to overcome the application limitations of advanced minimally invasive hemodynamic monitoring during toraco-abdominal surgery. With these options, hemodynamic monitoring will be used extensively to reduce postoperative complications and mortality. The customized strategy for patients, surgical intervention, and intraoperative losses is essential for both monitoring decision-making and achieving previously given goals for intraoperative fluid balance. This strategy has a direct impact on improving postoperative outcomes following surgery.
References
Makaryus R, Miller TE, Gan TJ. Current concepts of fluid management in enhanced recovery pathways. Br J Anaesth. 2018;120(2):376-83.
2. Ekeloef S, Larsen MH, Schou-Pedersen AM, Lykkesfeldt J, Rosenberg J, Gögenür I. Endothelial dysfunction in the early postoperative period after major colon cancer surgery. Br J Anaesth. 2017;118(2):200-6.
3. Milford EM, Reade MC. Resuscitation Fluid Choices to Preserve the Endothelial Glycocalyx. Crit Care. 2019;23(1):77.
4. Boer C, Bossers SM, Koning NJ. Choice of fluid type: physiological concepts and perioperative indications. Br J Anaesth. 2018;120(2):384-96.
5. Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Educ. 2020;20(9):321-8.
6. Manou-Stathopoulou V, Korbonits M, Ackland GL. Redefining the perioperative stress response: a narrative review. Br J Anaesth. 2019;123(5):570-83.
7. Vincent JL. Fluid management in the critically ill. Kidney Int. 2019;96(1):52-7.
8. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018;378(24):2263-74.
9. Messina A, Robba C, Calabrò L, Zambelli D, Iannuzzi F, Molinari E, et al. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Crit Care. 2021;25(1):43.
10. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55(1):91-115.
11. Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS. World J Surg. 2019;43(2):299-330.
12. Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, et al. Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient. World J Surg. 2023;47(8):1881-98.
13. Vaara ST, Korhonen AM, Kaukonen KM, Nisula S, Inkinen O, Hoppu S, et al. Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. Crit Care. 2012;16(5):R197.
14. Miller TE, Myles PS. Perioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019;130(5):825-32.
15. Casado D, López F, Martí R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus. 2010;23(7):523-8.
16. Bennett VA, Cecconi M. Perioperative fluid management: From physiology to improving clinical outcomes. Indian J Anaesth. 2017;61(8):614-21.
17. Jacob M, Chappell D, Rehm M. The 'third space'--fact or fiction? Best Pract Res Clin Anaesthesiol. 2009;23(2):145-57.
18. Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting-a clinical review. J Intensive Care. 2016;4:27.
19. Kendrick JB, Kaye AD, Tong Y, Belani K, Urman RD, Hoffman C, et al. Goal-directed fluid therapy in the perioperative setting. J Anaesthesiol Clin Pharmacol. 2019;35(Suppl 1):S29-S34.
20. Jessen MK, Vallentin MF, Holmberg MJ, Bolther M, Hansen FB, Holst JM, et al. Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2022;128(3):416-33.
21. Giglio M, Biancofiore G, Corriero A, Romagnoli S, Tritapepe L, Brienza N, et al. Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis. J Anesth Analg Crit Care. 2021;1(1):26.
22. Rollins KE, Lobo DN. Intraoperative Goal-directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials. Ann Surg. 2016;263(3):465-76.
23. Mukai A, Suehiro K, Watanabe R, Juri T, Hayashi Y, Tanaka K, et al. Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial. Br J Anaesth. 2020;125(6):953-61.
24. Veelo DP, van Berge Henegouwen MI, Ouwehand KS, Geerts BF, Anderegg MC, van Dieren S, et al. Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study. PLoS One. 2017;12(3):e0172806.
25. de Keijzer IN, Scheeren TWL. Perioperative Hemodynamic Monitoring: An Overview of Current Methods. Anesthesiol Clin. 2021;39(3):441-56.
26. Guarracino F, Bertini P, Pinsky MR. Heterogeneity of Cardiovascular Response to Standardized Sepsis Resuscitation. Crit Care. 2020;24(1):99.
27. Monge García MI, Gil Cano A, Gracia Romero M. Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. Crit Care. 2011;15(1):R15.
28. Aaen AA, Voldby AW, Storm N, Kildsig J, Hansen EG, Zimmermann-Nielsen E, et al. Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial. Br J Anaesth. 2021;127(4):521-31.
29. Wang Y, Zhang Y, Zheng J, Dong X, Wu C, Guo Z, et al. Intraoperative pleth variability index-based fluid management therapy and gastrointestinal surgical outcomes in elderly patients: a randomised controlled trial. Perioper Med (Lond). 2023;12(1):16.
30. Benes J, Kasperek J, Smekalova O, Tegl V, Kletecka J, Zatloukal J. Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery-A Narrative Review. J Pers Med. 2023;13(3).
31. Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6(1):111.
32. Monnet X, Teboul JL. My patient has received fluid. How to assess its efficacy and side effects? Ann Intensive Care. 2018;8(1):54.
33. Biais M, de Courson H, Lanchon R, Pereira B, Bardonneau G, Griton M, et al. Mini-fluid Challenge of 100 ml of Crystalloid Predicts Fluid Responsiveness in the Operating Room. Anesthesiology. 2017;127(3):450-6.
34. https://litfl.com/picco/.
35. https://www.lidco.com/wp-content/uploads/2017/03/5559-NHP-one-pager-flyer-2.pdf.
36. Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12(1):16.
37. Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. The emerging concept of fluid tolerance: A position paper. J Crit Care. 2022;71:154070.
38. Pillinger NL, Kam P. Endothelial glycocalyx: basic science and clinical implications. Anaesth Intensive Care. 2017;45(3):295-307.
39. Saugel B, Michard F, Scheeren TWL. Goal-directed therapy: hit early and personalize! J Clin Monit Comput. 2018;32(3):375-7.
40. Xing X, Gao Y, Wang H, Qu S, Huang C, Zhang H, et al. Correlation of fluid balance and postoperative pulmonary complications in patients after esophagectomy for cancer. J Thorac Dis. 2015;7(11):1986-93.
41. Brandstrup B. Finding the Right Balance. N Engl J Med. 2018;378(24):2335-6.
42. Marx G, Meybohm P, Schuerholz T, Lotz G, Ledinko M, Schindler AW, et al. Impact of a new balanced gelatine on electrolytes and pH in the perioperative care. PLoS One. 2019;14(4):e0213057.
2. Ekeloef S, Larsen MH, Schou-Pedersen AM, Lykkesfeldt J, Rosenberg J, Gögenür I. Endothelial dysfunction in the early postoperative period after major colon cancer surgery. Br J Anaesth. 2017;118(2):200-6.
3. Milford EM, Reade MC. Resuscitation Fluid Choices to Preserve the Endothelial Glycocalyx. Crit Care. 2019;23(1):77.
4. Boer C, Bossers SM, Koning NJ. Choice of fluid type: physiological concepts and perioperative indications. Br J Anaesth. 2018;120(2):384-96.
5. Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Educ. 2020;20(9):321-8.
6. Manou-Stathopoulou V, Korbonits M, Ackland GL. Redefining the perioperative stress response: a narrative review. Br J Anaesth. 2019;123(5):570-83.
7. Vincent JL. Fluid management in the critically ill. Kidney Int. 2019;96(1):52-7.
8. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018;378(24):2263-74.
9. Messina A, Robba C, Calabrò L, Zambelli D, Iannuzzi F, Molinari E, et al. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Crit Care. 2021;25(1):43.
10. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55(1):91-115.
11. Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS. World J Surg. 2019;43(2):299-330.
12. Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, et al. Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient. World J Surg. 2023;47(8):1881-98.
13. Vaara ST, Korhonen AM, Kaukonen KM, Nisula S, Inkinen O, Hoppu S, et al. Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. Crit Care. 2012;16(5):R197.
14. Miller TE, Myles PS. Perioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019;130(5):825-32.
15. Casado D, López F, Martí R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus. 2010;23(7):523-8.
16. Bennett VA, Cecconi M. Perioperative fluid management: From physiology to improving clinical outcomes. Indian J Anaesth. 2017;61(8):614-21.
17. Jacob M, Chappell D, Rehm M. The 'third space'--fact or fiction? Best Pract Res Clin Anaesthesiol. 2009;23(2):145-57.
18. Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting-a clinical review. J Intensive Care. 2016;4:27.
19. Kendrick JB, Kaye AD, Tong Y, Belani K, Urman RD, Hoffman C, et al. Goal-directed fluid therapy in the perioperative setting. J Anaesthesiol Clin Pharmacol. 2019;35(Suppl 1):S29-S34.
20. Jessen MK, Vallentin MF, Holmberg MJ, Bolther M, Hansen FB, Holst JM, et al. Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2022;128(3):416-33.
21. Giglio M, Biancofiore G, Corriero A, Romagnoli S, Tritapepe L, Brienza N, et al. Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis. J Anesth Analg Crit Care. 2021;1(1):26.
22. Rollins KE, Lobo DN. Intraoperative Goal-directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials. Ann Surg. 2016;263(3):465-76.
23. Mukai A, Suehiro K, Watanabe R, Juri T, Hayashi Y, Tanaka K, et al. Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial. Br J Anaesth. 2020;125(6):953-61.
24. Veelo DP, van Berge Henegouwen MI, Ouwehand KS, Geerts BF, Anderegg MC, van Dieren S, et al. Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study. PLoS One. 2017;12(3):e0172806.
25. de Keijzer IN, Scheeren TWL. Perioperative Hemodynamic Monitoring: An Overview of Current Methods. Anesthesiol Clin. 2021;39(3):441-56.
26. Guarracino F, Bertini P, Pinsky MR. Heterogeneity of Cardiovascular Response to Standardized Sepsis Resuscitation. Crit Care. 2020;24(1):99.
27. Monge García MI, Gil Cano A, Gracia Romero M. Dynamic arterial elastance to predict arterial pressure response to volume loading in preload-dependent patients. Crit Care. 2011;15(1):R15.
28. Aaen AA, Voldby AW, Storm N, Kildsig J, Hansen EG, Zimmermann-Nielsen E, et al. Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial. Br J Anaesth. 2021;127(4):521-31.
29. Wang Y, Zhang Y, Zheng J, Dong X, Wu C, Guo Z, et al. Intraoperative pleth variability index-based fluid management therapy and gastrointestinal surgical outcomes in elderly patients: a randomised controlled trial. Perioper Med (Lond). 2023;12(1):16.
30. Benes J, Kasperek J, Smekalova O, Tegl V, Kletecka J, Zatloukal J. Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery-A Narrative Review. J Pers Med. 2023;13(3).
31. Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6(1):111.
32. Monnet X, Teboul JL. My patient has received fluid. How to assess its efficacy and side effects? Ann Intensive Care. 2018;8(1):54.
33. Biais M, de Courson H, Lanchon R, Pereira B, Bardonneau G, Griton M, et al. Mini-fluid Challenge of 100 ml of Crystalloid Predicts Fluid Responsiveness in the Operating Room. Anesthesiology. 2017;127(3):450-6.
34. https://litfl.com/picco/.
35. https://www.lidco.com/wp-content/uploads/2017/03/5559-NHP-one-pager-flyer-2.pdf.
36. Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12(1):16.
37. Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. The emerging concept of fluid tolerance: A position paper. J Crit Care. 2022;71:154070.
38. Pillinger NL, Kam P. Endothelial glycocalyx: basic science and clinical implications. Anaesth Intensive Care. 2017;45(3):295-307.
39. Saugel B, Michard F, Scheeren TWL. Goal-directed therapy: hit early and personalize! J Clin Monit Comput. 2018;32(3):375-7.
40. Xing X, Gao Y, Wang H, Qu S, Huang C, Zhang H, et al. Correlation of fluid balance and postoperative pulmonary complications in patients after esophagectomy for cancer. J Thorac Dis. 2015;7(11):1986-93.
41. Brandstrup B. Finding the Right Balance. N Engl J Med. 2018;378(24):2335-6.
42. Marx G, Meybohm P, Schuerholz T, Lotz G, Ledinko M, Schindler AW, et al. Impact of a new balanced gelatine on electrolytes and pH in the perioperative care. PLoS One. 2019;14(4):e0213057.
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2025/12/19
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