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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2/2015

01-02-2015 | Review Article/Brief Review

Inter-device differences in monitoring for goal-directed fluid therapy

Authors: Robert H. Thiele, MD, Karsten Bartels, MD, Tong-Joo Gan, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 2/2015

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Abstract

Purpose

Goal-directed fluid therapy is an integral component of many Enhanced Recovery After Surgery (ERAS) protocols currently in use. The perioperative clinician is faced with a myriad of devices promising to deliver relevant physiologic data to better guide fluid therapy. The goal of this review is to provide concise information to enable the clinician to make an informed decision when choosing a device to guide goal-directed fluid therapy.

Principal findings

The focus of many devices used for advanced hemodynamic monitoring is on providing measurements of cardiac output, while other, more recent, devices include estimates of fluid responsiveness based on dynamic indices that better predict an individual’s response to a fluid bolus. Currently available technologies include the pulmonary artery catheter, esophageal Doppler, arterial waveform analysis, photoplethysmography, venous oxygen saturation, as well as bioimpedance and bioreactance. The underlying mechanistic principles for each device are presented as well as their performance in clinical trials relevant for goal-directed therapy in ERAS.

Conclusions

The ERAS protocols typically involve a multipronged regimen to facilitate early recovery after surgery. Optimizing perioperative fluid therapy is a key component of these efforts. While no technology is without limitations, the majority of the currently available literature suggests esophageal Doppler and arterial waveform analysis to be the most desirable choices to guide fluid administration. Their performance is dependent, in part, on the interpretation of dynamic changes resulting from intrathoracic pressure fluctuations encountered during mechanical ventilation. Evolving practice patterns, such as low tidal volume ventilation as well as the necessity to guide fluid therapy in spontaneously breathing patients, will require further investigation.
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Metadata
Title
Inter-device differences in monitoring for goal-directed fluid therapy
Authors
Robert H. Thiele, MD
Karsten Bartels, MD
Tong-Joo Gan, MD
Publication date
01-02-2015
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 2/2015
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-014-0265-z

Other articles of this Issue 2/2015

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2/2015 Go to the issue

Editorials

Spread and adoption of enhanced recovery from elective surgery in the English National Health Service

Review Article/Brief Review

What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways?

Review Article/Brief Review

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

Review Article/Brief Review

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Review Article/Brief Review

Perioperative catabolism

Special Article

Enhanced Recovery After Surgery (ERAS)