Fluid Management Using Minimally-invasive Hemodynamic Monitoring

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  • SUEHIRO Koichi
    Department of Anesthesiology, Osaka City University Graduate School of Medicine

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  • 低侵襲血行動態モニターを用いた輸液管理

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<p>Postoperative complications are the main cause of perioperative mortality and morbidity. High-risk surgical patients account for only 12.5% of all surgical procedures, but for more than 80% of postoperative mortality. Perioperative hemodynamic optimization using goal-directed therapy（GDT）has become common due to its ability to improve both of postoperative short and long-term outcomes in patients undergoing higher risk surgery. 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. Thus, GDT has grown to be considered as the standard of perioperative care, because it has demonstrated strong clinical evidence to decrease the complication rate. Despite these evidence-based recommendations, the implementation of GDT is still poorly achieved in daily clinical practice. This current review will provide a brief up-to-date overview of GDT, discuss current clinical practice, analyze why implementation has been limited, and describe the newer closed-loop GDT concept along with its potential risks and benefits.</p>

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