ERAS: Goal Directed Fluid Therapy
Basic, Organ-Based and Clinical Sciences
Goal Directed Fluid Therapy (GDT) is a tenant of ERAS protocols, utilizing an intra-arterial waveform for automated measurements of pulse pressure variations (PPV) or stroke volume variation (SVV) in order to determine response to fluid boluses. Essentially, if the respiratory variations in the arterial waveform exceed 10-15%, the patient is assumed to be fluid responsive and would likely benefit from a bolus (typically 250 mL) of a balanced crystalloid solution. Fluid resuscitation should be held once the parameter has fallen to <10% to avoid hypervolemia.
Studies indicate this method is a superior deviation from the historical “fixed-volume” or liberal fluid approach. In a meta-analysis published by Chong et al, GDT was associated with lower risk of mortality, pneumonia, acute kidney injury, and wound infection as well as portended a shorter length of hospital stay.2 GDT appears to be most effective in the context of ERAS protocols, which implement multiple processes reducing fluid imbalances throughout the perioperative period, including avoidance of pre-operative dehydration and encouraging early post-operative alimentation and ambulation.
Grassi, P, et al. Pulse Pressure Variation as a Predictor of Fluid Responsiveness in Mechanically Ventilated Patients with Spontaneous Breathing Activity: a Pragmatic Observational Study. HSR Proceedings in Intensive Care & Cardiovascular Anesthesia, EDIMES Edizioni Internazionali Srl, 2013
See also Enhanced recovery protocol