title: A systematic review of goal directed fluid therapy: rating of evidence for goals and monitoring methods.
abstract: OBJECTIVE
  To review the literature on goal directed fluid therapy and evaluate the quality of evidence for each combination of goal and monitoring method.
  
  
  METHODS
  A search of major digital databases and hand search of references was conducted. All studies assessing the clinical utility of a specific fluid therapy goal or set of goals using any monitoring method were included. Data was extracted using a pre-determined pro forma and papers were evaluated using GRADE principles to assess evidence quality.
  
  
  RESULTS
  Eighty-one papers met the inclusion criteria, investigating 31 goals and 22 methods for monitoring fluid therapy in 13052 patients. In total there were 118 different goal/method combinations. Goals with high evidence quality were central venous lactate and stroke volume index. Goals with moderate quality evidence were sublingual microcirculation flow, the oxygen extraction ratio, cardiac index, cardiac output, and SVC collapsibility index.
  
  
  CONCLUSIONS
  This review has highlighted the plethora of goals and methods for monitoring fluid therapy. Strikingly, there is scant high quality evidence, in particular for non-invasive G/M combinations in non-operative and non-intensive care settings. There is an urgent need to address this research gap, which will be helped by methodologies to compare utility of G/M combinations.
authors.affiliation: The University Of Auckland, Auckland, New Zealand.
authors.forename: Heath
authors.initials: H
authors.lastname: Wilms
authors.affiliation: The University Of Auckland, Auckland, New Zealand.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Mittal
authors.affiliation: The University Of Auckland, Auckland, New Zealand.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Haydock
authors.affiliation: The University Of Auckland, Auckland, New Zealand.
authors.forename: Marc
authors.initials: M
authors.lastname: van den Heever
authors.affiliation: The University Of Auckland, Auckland, New Zealand.
authors.forename: Marcello
authors.initials: M
authors.lastname: Devaud
authors.affiliation: The University Of Auckland, Auckland, New Zealand. Electronic address: j.windsor@auckland.ac.nz.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D002302:Cardiac Output / Q000502:physiology*; D055317:Evidence-Based Practice; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009060:Mouth Floor / Q000502:physiology; D010101:Oxygen Consumption / Q000502:physiology; D010347:Patient Care Planning; D013318:Stroke Volume / Q000502:physiology
chemical_list: D019344:Lactic Acid
keywords: Endpoint; Fluid therapy; Goals; Physiologic monitoring; Treatment outcome