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Perioperative goal directed therapy using automated closed-loop fluid management: the future?
Anaesthesiol Intensive Ther. 2015; 47(5):517-23.AI

Abstract

 Although surgery has become much safer, it has also becoming increasingly more complex and perioperative complications continue to impact millions of patients worldwide each year. Perioperative hemodynamic optimization utilizing Goal Directed Therapy (GDT) has attracted considerable interest within the last decade due to its ability to improve postoperative short and long-term outcomes in patients undergoing higher risk surgeries. The concept of GDT in this context can be loosely defined as collecting data from minimally invasive hemodynamic monitors with the intention of using such data (flow-related parameters and/or dynamic parameters of fluid responsiveness) to titrate therapeutic interventions (intravenous fluids and/or inotropic therapy administration) with the ultimate aim of optimizing end organ tissue perfusion. Recently, the increasing amount of evidence supporting the implementation of GDT strategies has been considered so robust as to allow for the creation of national recommendations in the United Kingdom (UK), France, and Europe. These recommendations from such influential scientific societies and the potential clinical and economic benefits of GDT protocols need to also be examined within the current shift from a "pay for service" to a "pay for performance" health care system. This shift is strongly encouraged within emerging systems such as the Perioperative Surgical Home (PSH) paradigm from the United States. As a result, hospitals and clinicians around the world have become increasingly incentivized to implement perioperative hemodynamic optimization using GDT strategies within their departments. Unfortunately, its adoption continues to be quite limited and a lack of standardized criteria for perioperative fluid administrations has resulted in significant clinical variability among practitioners. This current review will provide a brief up-to-date overview of GDT, discuss current clinical practice, analyze why implementation has been limited and finally, describe the newer closed-loop GDT concept along with its potential risks and benefits.

Authors+Show Affiliations

Department of Anaesthesiology, CUB Erasme, Université Libre de Bruxelles, Belgium. joosten-alexandre@hotmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26578397

Citation

Joosten, Alexandre, et al. "Perioperative Goal Directed Therapy Using Automated Closed-loop Fluid Management: the Future?" Anaesthesiology Intensive Therapy, vol. 47, no. 5, 2015, pp. 517-23.
Joosten A, Alexander B, Delaporte A, et al. Perioperative goal directed therapy using automated closed-loop fluid management: the future? Anaesthesiol Intensive Ther. 2015;47(5):517-23.
Joosten, A., Alexander, B., Delaporte, A., Lilot, M., Rinehart, J., & Cannesson, M. (2015). Perioperative goal directed therapy using automated closed-loop fluid management: the future? Anaesthesiology Intensive Therapy, 47(5), 517-23. https://doi.org/10.5603/AIT.a2015.0069
Joosten A, et al. Perioperative Goal Directed Therapy Using Automated Closed-loop Fluid Management: the Future. Anaesthesiol Intensive Ther. 2015;47(5):517-23. PubMed PMID: 26578397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative goal directed therapy using automated closed-loop fluid management: the future? AU - Joosten,Alexandre, AU - Alexander,Brenton, AU - Delaporte,Amélie, AU - Lilot,Marc, AU - Rinehart,Joseph, AU - Cannesson,Maxime, Y1 - 2015/11/18/ PY - 2015/09/29/received PY - 2015/10/25/accepted PY - 2015/11/19/entrez PY - 2015/11/19/pubmed PY - 2016/12/15/medline KW - cardiac output KW - closed-loop KW - goal directed therapy KW - hemodynamic optimization SP - 517 EP - 23 JF - Anaesthesiology intensive therapy JO - Anaesthesiol Intensive Ther VL - 47 IS - 5 N2 -  Although surgery has become much safer, it has also becoming increasingly more complex and perioperative complications continue to impact millions of patients worldwide each year. Perioperative hemodynamic optimization utilizing Goal Directed Therapy (GDT) has attracted considerable interest within the last decade due to its ability to improve postoperative short and long-term outcomes in patients undergoing higher risk surgeries. The concept of GDT in this context can be loosely defined as collecting data from minimally invasive hemodynamic monitors with the intention of using such data (flow-related parameters and/or dynamic parameters of fluid responsiveness) to titrate therapeutic interventions (intravenous fluids and/or inotropic therapy administration) with the ultimate aim of optimizing end organ tissue perfusion. Recently, the increasing amount of evidence supporting the implementation of GDT strategies has been considered so robust as to allow for the creation of national recommendations in the United Kingdom (UK), France, and Europe. These recommendations from such influential scientific societies and the potential clinical and economic benefits of GDT protocols need to also be examined within the current shift from a "pay for service" to a "pay for performance" health care system. This shift is strongly encouraged within emerging systems such as the Perioperative Surgical Home (PSH) paradigm from the United States. As a result, hospitals and clinicians around the world have become increasingly incentivized to implement perioperative hemodynamic optimization using GDT strategies within their departments. Unfortunately, its adoption continues to be quite limited and a lack of standardized criteria for perioperative fluid administrations has resulted in significant clinical variability among practitioners. This current review will provide a brief up-to-date overview of GDT, discuss current clinical practice, analyze why implementation has been limited and finally, describe the newer closed-loop GDT concept along with its potential risks and benefits. SN - 1731-2531 UR - https://www.unboundmedicine.com/medline/citation/26578397/Perioperative_goal_directed_therapy_using_automated_closed_loop_fluid_management:_the_future L2 - https://doi.org/10.5603/AIT.a2015.0069 DB - PRIME DP - Unbound Medicine ER -