Perioperative Goal Directed Therapy

Perioperative Goal Directed Fluid Therapy (GDT) is an approach to fluid and hemodynamic management based on physiologic parameters such as stroke volume index, stroke volume variation (SVV), and corrected flow time (esophageal Doppler, FTc). Standard ASA monitors such as heart rate and blood pressure, along with other parameters such as urine output, base deficit, and plethysmographic perfusion index may be used as well. Typically an algorithm or other set of guidelines is used for each patient.

Recently it has become clear that excess fluid and salt is harmful to patients undergoing major surgery. Likewise, hypovolemia with its associated poor tissue perfusion can cause complications. The risk of complications rises with both hypo- and hypervolemia, making administration of the “right” amount of fluid desirable.

 

Adapted from Bellamy MC: Wet, dry or something else? Br J Anaesth 2006;97:755-7.

Using flow-based parameters such as those provided by minimally invasive cardiac output monitors such as the Edwards FloTrac and the esophageal Doppler based Deltex CardioQ allows targeted fluid administration and rapid hemodynamic problem solving. Other monitors may be used, ranging from noninvasive to invasive.

Almost anypatient presenting for surgery can benefit from GDT. The greatest gains can be achieved with higher-risk, major surgeries in which fluid shifts and blood loss are substantial. The following is a list of surgeries in which GDT will likely provide substantial benefit, and are the “recommended” list at UCSD:

Goal Directed Therapy for high risk surgeries:

  • Laparotomy Exploratory
  • Resection Bowel Large, Colectomy
  • Whipple Pancreato-duodenectomy
  • Hepatectomy
  • Splenectomy
  • Transplant Kidney
  • Dissection Radical Neck
  • Bypass Aorto-Femoral / Popliteal / Axillary
  • Open Hysterectomy Abdominal Total / Bilateral Salpingo-oophorectomy
  • Chemotherapy Hyperthermic Interperitoneal
  • Laminectomy Fusion w/ Instrumentation ( > 3 levels)
  • Arthroplasty Hip, Knee, Elbow
  • Excision Burn
  • Cystoprostatectomy w/ Ileal Conduit
  • Radical Cystectomy

This website contains educational information and links about GDT, minimally invasive monitors, and the UC San Diego GDT algorithms.

Resources, Education and Links
UC San Diego GDT Algorithms