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



8 to 12 mm Hg

re-evaluate in 5 minutes


< 8 mm Hg

volume challenge with 500 mL crystalloid



• 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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