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Table 1 Trials of goal-directed therapy [23,29-59]

From: Perioperative fluid therapy: a statement from the international Fluid Optimization Group

Protocols Fluids GDT versus control   
Population GDT endpoints GDT therapy Control protocol Crystalloids Colloids Outcomes GDT versus control Reference
Elective cardiac surgery ΔSV < 10% (esophageal Doppler) Bolus 200 ml colloid Standard of care Less More Reduction of gut mucosal hypoperfusion, less postoperative complications, shorter ICU stay, shorter HLOS Mythen and Webb [29]
ΔCVP < 3 mmHg
Proximal femoral fracture repair FTc > 400 ms, ΔSV < 10% (esophageal Doppler) Bolus 3 ml/kg colloid Standard of care Similar More Shorter HLOS Sinclair et al. [30]
Transthoracic esophagectomy CVP < 5 mmHg Restrictive regimen Standard of care No data No data Less postoperative pulmonary complications Kita et al. [31]
Major bowel surgery FTc > 350 ms Bolus 3 ml/kg colloid Standard of care No data More Less critical care admission Conway et al. [32]
ΔSV < 10% (Doppler)
Major elective surgery FTc > 350 ms Bolus 200 ml colloid Standard of care (HR, CVP, MAP, UO) Similar More Less PONV, earlier oral solid intake, shorter HLOS Gan et al. [33]
ΔSV < 10% (Doppler)
Proximal femoral fracture repair Doppler - FTc > 400 ms, Bolus 200 ml colloid Standard of care (without CVP or Doppler) Similar More Less intraoperative hypotension, sooner medically fit for discharge Venn et al. [34]
ΔSV < 10%
CVP - ΔCVP < 5 mmHg
Elective colorectal resection Maintaining preoperative body weight Restrictive regimen Standard of care Less Similar Less postoperative complications (tissue healing, cardiopulmonary) Brandstrup et al. [35]
High-risk surgical patients (≥60 years old) DO2 = 550 to 600 ml/min/m2 Fluids, inotropes, vasodilators, vasopressors, RBC Standard of care (without PAC) No data No data More pulmonary embolism Sandham et al. [36]
CI = 3.5 to 4.5 l/min/m2
MAP = 70 mmHg
HR < 120 bpm, Ht ≥ 27%
Colorectal resection ΔSV < 10% (Doppler) Bolus 250 ml colloid Routine monitoring (CVP = 12 to 15 mmHg) Similar More Shorter recovery of gut function, less morbidity, shorter HLOS Wakeling et al. [37]
ΔCVP < 3 mmHg
Elective colorectal resection FTc > 350 ms 7 ml/kg first bolus colloid, then bolus 3 ml/kg colloid Standard of care (without bolus) Similar Similar Less inotrope use, earlier diet, less days to medically fit, shorter HLOS Noblett et al. [38]
ΔSV < 10% (Doppler)
Low-risk patients off-pump coronary surgery PAC No data Standard of care (CVP) No data No data More use of inotropes Resano et al. [39]
Major abdominal surgery O2ER < 27% Colloid bolus, RBC, dobutamine Standard of care (MAP, UO) No data No data Less organ failure, shorter HLOS Donati et al. [40]
Cardiac bypass surgery GEDVI = 640 ml/m2 Bolus 500 ml, vasopressors Standard of care (CVP, MAP, clinical evaluation) Similar More Shorter and reduced need for vasopressors, mechanical ventilation, and ICU therapy Goepfert et al. [41]
CI > 2.5 l/min/m2
MAP = 70 mmHg  
High-risk surgery ΔPP < 10% Bolus colloid Standard of care Similar More Less postoperative complications, shorter time of mechanical ventilation, ICU stay and HLOS Lopes et al. [42]
Moderate to high-risk cardiac surgery DO2 = 450 to 600 ml/min/m2 Bolus 100 ml colloid CVP = 6 to 8 mmHg Similar More Lower number of adjustments of inotropic agents Kapoor et al. [43]
CI = 2.5 to 4.2 l/min/m2 MAP = 90 to 105 mmHg
SVI = 30 to 65 ml/beat/m2 UO > 1 ml/kg/h
ScvO2 > 70%, SVV < 10%
Off-pump coronary surgery ITBVI > 850 ml/m2 Bolus 500 ml colloid Standard of care (MAP, CVP, HR) Similar More Shorter HLOS Smetkin et al. [44]
ScvO2 > 60%
Laparoscopic segmental colectomy 2 GDT groups: Bolus 200 ml colloid or 300 ml crystalloid Standard of care More (GDT crystalloid) More (GDT colloid) More postoperative complications on group GDT colloid Senagore et al. [45]
ΔSV < 10%
Crystalloids versus colloids
Major abdominal surgery PVI < 13% Bolus 250 ml colloid (norepinephrine to MAP > 65 mmHg) Standard of care (MAP, CVP) Less Similar Lower lactate levels Forget et al. [46]
Elective surgery for GI malignancy Serum lactate < 1.6 mmol/l Bolus 250 to 1,000 ml colloid (depending serum lactate) Restrictive regimen Similar Similar Less systemic complications in patients that need postoperative supplementary fluids Wenkui et al., [47]
Major abdominal surgery Peak aortic flow velocity < 13% (Doppler) Bolus 250 ml, vasopressors, dobutamine, restrictive crystalloids Standard of care (12 ml/kg/h crystalloids) Less (patients with complication) More (patients with complication) More postoperative complications Futier et al. [48]
Peripheral artery bypass grafting CI > 2.5 l/min/m Bolus 250 ml colloid, dobutamine Standard of care (MAP, CVP) No data Similar No difference between groups Van der Linden et al. [49]
Major abdominal surgery CI > 2.5 l/min/m2 Bolus 500 ml crystalloid, bolus 250 ml colloid, dobutamine, norepinephrine Standard of care (MAP, CVP, UO) Less More Less postoperative complications, shorter HLOS Mayer et al. [50]
SVI > 35 ml/beat/m2
MAP > 65 mmHg
Elective intra-abdominal surgery in high-risk patients SVV < 10% Bolus 3 ml/kg colloid, dobutamine Standard of care (MAP > 65 mmHg, HR < 100 bpm, CVP = 8 to 15 mmHg, UO > 0.5 ml/kg/h) Similar More Better intraoperative hemodynamic stability, lower serum lactate, less postoperative complications Benes et al. [51]
CI > 2.5 l/min/m2
Elective total hip replacement DO2 > 600 ml/min/m2 Bolus 250 ml colloid, dobutamine, RBC Standard of care (MAP) More More Less postoperative complications, (hypotension, cardiovascular) Cecconi et al. [52]
ΔSV < 10%, Hb > 10 g/dl
Elective colorectal surgery ΔSV < 10% Bolus 200 ml colloid Zero balance intraoperative fluids (MAP > 60 mmHg) Similar More No difference between groups Brandstrup et al. [23]
Major abdominal surgery (cirrhotic patients) 2 GDT groups: Bolus 250 ml LR followed by 3 ml/kg colloid Same for both groups Similar Similar No difference between groups Abdullah et al. [53]
PVI < 13%
FTc > 350 ms
Major colorectal surgery ΔSV < 10% Bolus 200 ml colloid Standard of care Similar More More blood loss and need for transfusion in OR, longer HLOS Challand et al. [54]
Noncardiac major surgery FTc > 300 ms, ΔSV < 10% Bolus 200 ml colloid Bolus 200 ml crystalloid Less More Less transfusion of FFP, better hemodynamic stability Feldheiser et al. [55]
MAP > 70 mmHg
CI > 2.5 l/min/m2
Elective colectomy FTc > 400 ms 7 ml/kg first bolus colloid, then bolus 3 ml/kg colloid Restrictive regimen Similar More No differences in outcomes Srinivasa et al. [56]
ΔSV < 10% (HR, MAP, UO)
Cytoreductive surgery (ovarian cancer) ΔSV < 10% Bolus 200 ml 200 ml crystalloid Less More Better hemodynamic stability, less FFP transfusion Feldheiser et al. [57]
Major abdominal surgery CI > 2.5 l/min/m2 Fluids, dobutamine, vasopressors Standard of care Similar Similar Less postoperative complications, lower infection rate Salzwedel et al. [58]
PPV < 10%
MAP > 65 mmHg
Major abdominal surgery CO SV Bolus 250 ml colloid Standard of care (CVP) Less More No difference in outcomes Pearse et al. [59]
  1. Individual clinical trials and meta-analyses have shown that different fluid therapy regimens produce significantly different clinical outcomes and have resulted in considerable controversy as to the best approach. This table represents a summary of the known peer-reviewed GDT trials including their physiologic targets, fluids used, and outcomes measured.