title: Monitoring needs and goal-directed fluid therapy within an enhanced recovery program.
abstract: Patients having major abdominal surgery need perioperative fluid supplementation; however, enhanced recovery principles mitigate against many of the factors that traditionally led to relative hypovolemia in the perioperative period. An estimate of fluid requirements for abdominal surgery can be made but individualization of fluid prescription requires consideration of clinical signs and hemodynamic variables. The literature supports goal-directed fluid therapy. Application of this evidence to justify stroke volume optimization in the setting of major surgery within an enhanced recovery program is controversial. This article places the evidence in context, reviews controversies, and suggests implications for current practice and future research.
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Plymouth Hospitals NHS Trust, Plymouth University Peninsula School of Medicine, Plymouth PL6 8DH, UK. Electronic address: gary.minto@nhs.net.
authors.forename: Gary
authors.initials: G
authors.lastname: Minto
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County Hospital, University of Surrey, Guildford GU1 7XX, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Scott
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Miller
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002302:Cardiac Output; D005440:Fluid Therapy / Q000379:methods*; D006040:Goals; D006801:Humans; D020896:Hypovolemia / Q000517:prevention & control; D016343:Monitoring, Intraoperative; D020380:Needs Assessment; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*
keywords: Cardiac output monitoring; Colorectal surgery; Enhanced recovery; Fluid therapy