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Scritto da Critical Care
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 There is increasing evidence that hemodynamic optimization by fluid loading, in particular when performed in the early phase of surgery is beneficial in high-risk surgery patients leads to a reduction of postoperative complications and may even improve long-term outcome. However, it is also true that goal goal-directed strategies of fluid optimization focussing on cardiac output optimization have so far not found their way to clinical routine yet. Reasons are manifold: Disbelief on the level of evidence, on the accuracy and practicability of the necessary monitoring technology, and economical reasons. The FOCCUS trial examined with regard to perioperative fluid optimization a very basic approach; a standardized volume load with 25 ml/kg cristalloids over 6 hrs immediately prior to scheduled surgery was tested in high risk surgical patients. The hypothesis was that this intervention leads to a compensation of pre-operative fluid deficit caused by overnight fasting, and results in improved perioperative fluid homeostasis with less postoperative complications, and earlier hospital discharge. However, the primary study endpoints did not improve significantly. This points toward the fact first, the differentiation between fluid deficit and intravascular volume loss must be recognized in treatment strategies, and that that also protocolized treatment strategies always needs to be tailored to suit the individual needs of a patient and the individual clinical scenarios.
Fonte: Critical Care |
