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Can goal-directed fluid therapy decrease the use of blood and hemoderivates in surgical patients?
Minerva Anestesiol. 2020 Apr 06 [Online ahead of print]MA

Abstract

The purpose of Goal Directed Therapy (GDT) is to improve patient outcome by the optimization of hemodynamic status, as it is considered that many perioperative complications are related to microcirculatory disturbance due to an imbalance between oxygen delivery and consumption. The application of GDT protocols incorporating the assessment and optimization of patients' intravascular status should theoretically lead to a reduction in perioperative bleeding and transfusion requirements, as both hypervolemia and hypovolemia and their consequences such as dilutional coagulopathy, anaemia and inadequate oxygen delivery to the tissues are avoided. However, the research reporting decreased usage of blood products in patients which received targeted fluid management is sparse; decreased blood loss and transfusion requirements were reported in spine surgery using GDT, while studies in abdominal or cardiac surgery did not consistently report significant decreases in blood products transfusion when GDT were applied. These heterogenous results reported can be explained by the differences between the GDT protocols used, as the differences in therapeutic goals can impact on blood transfusion requirements. In the future, the GDT protocols should include not only the prediction of fluid responsiveness and optimization of hemodynamic status, but also the assessment of microcirculation and measures to improve tissue oxygenation, parameters which can also guide the decision for blood product transfusion. A better standardization of GDT algorithms is also required in order to perform a more accurate assessment of the effects of applying GDT on the consumption of blood products.

Authors+Show Affiliations

Anesthesia and Intensive Care Department, Fundeni Clinics, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania - danatomescu@gmail.com. Third Department of Anestesiology and Intensive Care Fundeni Clinical Institute, Bucharest, Romania - danatomescu@gmail.com.Third Department of Anestesiology and Intensive Care Fundeni Clinical Institute, Bucharest, Romania.First Department of Cardiovascular Anesthesiology and Intensive Care "Prof. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32251569

Citation

Tomescu, Dana R., et al. "Can Goal-directed Fluid Therapy Decrease the Use of Blood and Hemoderivates in Surgical Patients?" Minerva Anestesiologica, 2020.
Tomescu DR, Scarlatescu E, Bubenek-Turconi ŞI. Can goal-directed fluid therapy decrease the use of blood and hemoderivates in surgical patients? Minerva Anestesiol. 2020.
Tomescu, D. R., Scarlatescu, E., & Bubenek-Turconi, Ş. I. (2020). Can goal-directed fluid therapy decrease the use of blood and hemoderivates in surgical patients? Minerva Anestesiologica. https://doi.org/10.23736/S0375-9393.20.14154-3
Tomescu DR, Scarlatescu E, Bubenek-Turconi ŞI. Can Goal-directed Fluid Therapy Decrease the Use of Blood and Hemoderivates in Surgical Patients. Minerva Anestesiol. 2020 Apr 6; PubMed PMID: 32251569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can goal-directed fluid therapy decrease the use of blood and hemoderivates in surgical patients? AU - Tomescu,Dana R, AU - Scarlatescu,Ecaterina, AU - Bubenek-Turconi,Şerban I, Y1 - 2020/04/06/ PY - 2020/4/7/entrez PY - 2020/4/7/pubmed PY - 2020/4/7/medline JF - Minerva anestesiologica JO - Minerva Anestesiol N2 - The purpose of Goal Directed Therapy (GDT) is to improve patient outcome by the optimization of hemodynamic status, as it is considered that many perioperative complications are related to microcirculatory disturbance due to an imbalance between oxygen delivery and consumption. The application of GDT protocols incorporating the assessment and optimization of patients' intravascular status should theoretically lead to a reduction in perioperative bleeding and transfusion requirements, as both hypervolemia and hypovolemia and their consequences such as dilutional coagulopathy, anaemia and inadequate oxygen delivery to the tissues are avoided. However, the research reporting decreased usage of blood products in patients which received targeted fluid management is sparse; decreased blood loss and transfusion requirements were reported in spine surgery using GDT, while studies in abdominal or cardiac surgery did not consistently report significant decreases in blood products transfusion when GDT were applied. These heterogenous results reported can be explained by the differences between the GDT protocols used, as the differences in therapeutic goals can impact on blood transfusion requirements. In the future, the GDT protocols should include not only the prediction of fluid responsiveness and optimization of hemodynamic status, but also the assessment of microcirculation and measures to improve tissue oxygenation, parameters which can also guide the decision for blood product transfusion. A better standardization of GDT algorithms is also required in order to perform a more accurate assessment of the effects of applying GDT on the consumption of blood products. SN - 1827-1596 UR - https://www.unboundmedicine.com/medline/citation/32251569/Can_goal-directed_fluid_therapy_decrease_the_use_of_blood_and_hemoderivates_in_surgical_patients L2 - https://www.minervamedica.it/index2.t?show=R02Y9999N00A20040601 DB - PRIME DP - Unbound Medicine ER -
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