Mayer et al reported a protocol for goal-directed intraoperative fluid therapy. Goal-directed fluid therapy is associated with fewer postoperative complications. The authors are from Klinikum Ludwigshafen in Germany.
Goal – both of the following:
(1) mean arterial pressure > 65 mm Hg
(2) urine output > 0.5 per kg per hour
Goal Met?
Central Venous Pressure
Plan
yes
8 to 12 mm Hg
re-evaluate in 5 minutes
no
< 8 mm Hg
volume challenge with 500 mL crystalloid
where:
• The other possible responses are not given in the flow diagram. The implementation includes decision points not in the protocol.
Response to Initial Bolus
Central Venous Pressure
goal met
re-evaluate after 5 minutes
goal not met
give a second bolus of 250 mL colloid
If the patient does not respond to the second bolus, then give a third bolus of 250 mL colloid.
.
If the person does not respond to the third bolus, then consider drug therapy (norepinephrine, dobutamine, vasodilators).
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