Optimisation of the high-risk surgical patient

Abstract

Perioperative haemodynamic optimisation is one of the few interventions in intensive care medicine that actually reduce postoperative mortality and complication rate. This process uses advanced haemodynamic monitoring in order to guide therapies to reach predefined goals. This review aims to summarise recent evidence on perioperative goal-directed therapy (GDT), pointing out some aspects that may merit further investigation. In summary, GDT must be implemented as early as possible; fluid therapy should be performed in accordance with the response of the preload reserve, goals should be individualised, and adequacy of the intervention should be assessed. Noninvasive or minimally invasive monitoring should be preferred over invasive techniques in order to avoid undesired complications. New drugs and technologies, particularly those exploring information from the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of perioperative optimisation.