Monitoring of peri-operative fluid administration by individualized goal-directed therapy.
BACKGROUND
In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess the use of strategies, parameters and monitors for goal-directed therapy.


METHODS
A MEDLINE search (1966 to 2 October 2006) was performed to identify studies in which a goal-directed therapeutic strategy was used to maximize flow-related haemodynamic parameters in surgical patients, as well as studies referenced from these papers. Furthermore, methods applied in these studies and other monitors with a potential for goal-directed therapy are described.


RESULTS
Nine studies were identified pertaining to fluid optimization during the intra- and post-operative period with goal-directed therapy. Seven studies (n = 725) found a reduced hospital stay. Post-operative nausea and vomiting (PONV) and ileus were reduced in three studies and complications were reduced in four studies. Of the monitors that may be applied for goal-directed therapy, only oesophageal Doppler has been tested adequately; however, several other options exist.


CONCLUSIONS
Goal-directed therapy with the maximization of flow-related haemodynamic variables reduces hospital stay, PONV and complications, and facilitates faster gastrointestinal functional recovery. So far, oesophageal Doppler is recommended, but other monitors are available and call for evaluation.
Bundgaard-Nielsen
M
M
Section of Surgical Pathophysiology, University of Copenhagen, Copenhagen, Denmark. morten.bundgaard-nielson@rh.hosp.dk
Holte
K
K
Secher
N H
NH
Kehlet
H
H
D000465:Algorithms; D005440:Fluid Therapy / Q000379:methods / Q000592:standards*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D020896:Hypovolemia / Q000517:prevention & control*; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care / Q000379:methods; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D018615:Ultrasonography, Doppler, Color
D006895:Hydroxyethyl Starch Derivatives