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Table 1 Trials of “goal-directed fluid therapy” (GDT) in abdominal surgery versus “standard therapy”

From: Fluid therapy in the perioperative setting—a clinical review

Author Surgery No. of patients/ASA Blinding/monitor/timing Primary outcome Intervention Preoperative fluid volume, mL (control vs. GDT) Intraoperative fluid volume, mL (control vs. GDT) Postoperative fluid volume, mL (control vs. GDT) Effect of GDT
Conway et al. [56] Elective bowel surgery 57/ASA I-III No blinding/ODM (CardioQ®)/intraoperative Cardiac output Optimizing SV (<10 %) and cFT (<350 ms) with HES 6 % Not given Coll: 19 mL/kg vs.28 mL/kg
Total: 55 mL/kg vs. 64 mL/kg
Not given ↑ SV and CO
→ LOS
→ Complications
↓ Critical care admission
Mortality: 1 (control) vs. 0 (GDT)
Gan et al. [55] Elective major urological or gynecological 100/ASA I-III No blinding/ODM (CardioQ®)/intraoperative LOS Optimizing cFT (<350 ms) and SV (<10 %) with HES 6 % Not given Coll: 282 vs. 847
Cryst: 4375 vs. 4405
Totala: 4775 vs. 5420
Not given ↓ LOS
→ Complications
↓ PONV
Mortality not reported.
Wakeling et al. [42].
2005
Elective colorectal resection 128/ASA II (media) Observer blinded/ODM (CardioQ®)/intraoperative LOS Optimizing SV (<10 %) with Haemaccel® or Gelofusine® 1000–2000 Hartmann’s solution from midnight Coll: 1500 vs. 2000
Cryst: 3000 vs. 3000
Total: not given
Not given
Early oral intake
↓ LOS
↓ Complications
↓ GI complications
Mortality: d30: non; d60: 1 (control) vs. 0 (GDT)
Noblett et al. [16] Elective colorectal resection 108/ASA II (median) Observer blinded/ODM (CardioQ®)/intraoperative LOS Optimizing SV (<10 %) and cFT (<350 ms) with Volplex® Not given Coll: 1209 vs. 1340 Cryst: 2625 vs. 2298
Total: not given
Not given
Early oral intake
↓ LOS
↓ Complications
↓ Critical care admission
↓ Interleukin 6 response
Mortality: 1 (control) vs. 0 (GDT)
Lopes et al. [52] Elective mixed GI and urological 33/ASA II-IV No blinding/IBPplus®/intraoperative LOS Optimizing PPV (≤10 %) with HES 6 % Not given Coll: 0 vs. 2247
Cryst: 1563 vs. 2176
Totala: 1694 vs. 4618
Not given
Patients transferred to ICU
↓ LOS
↓ Complications
↓ Mechanical ventilation
↓ ICU stay
Mortality: 5 (control) vs. 2 (GDT)
Buettner et al. [57] Elective general, urological, or gynecological 80/ASA I-III Not blinded. PiCCOplus®/intraoperative ScvO2 and serum lactate Optimizing SPV (<10 %) with HES 6 %, 130/0.4
(Voluven®) and vasopressors
Not given Coll: 1000 vs. 1500
Cryst: 4250 vs. 4500
Total: not given
Not given → ScvO2 or lactate
→ Complications
→ Mechanical ventilation
→ ICU stay
Mortality: 1 (control) vs. 0 (GDT)
Forget et al. [58] Elective mixed GI surgery 82/ASA II-III Observer blinded/Masimo Set®/intraoperative Whole blood lactate levels Optimizing PVI (>13 %) with HES 6 %, 130/0.4 (Voluven®) and vasopressors Not given Coll: 1003 vs. 890
Cryst: 1815 vs. 1363
Totala: 2918 vs. 2394
48 h postop. Coll: 358 vs. 268
Cryst: 3516 vs. 3107
↓ Lactate levels
→ Complications
→ Renal function
Mortality: 0 (control) vs. 2 (GDT)
Mayer et al. [41] Elective mixed GI surgery 60/ASA III Observer blinded/FloTrac®, Vigileo/intraoperative LOS Optimizing CI (≥2.5 L/min/m2) with crystalloids, colloids, inotropes and vasopressors Not given Coll: 817 vs. 1188
Cryst: 3153 vs. 2489
Totala: 4494 vs. 4528
Not given ↓ LOS
↓ Complications
→ Mechanical ventilation
→ ICU stay
Mortality: 2 (control) vs. 2 (GDT)
Benes et al. [54] Elective mixed GI and vascular surgery 120/ASA II-IV Observer blinded/FloTrac®, Vigileo/intraoperative Complications Optimizing SVV (<10 %) with HES 6 %, 130/0.4 (Voluven®) and inotropes Not given Coll: 1000 vs. 1425
Cryst: 2459 vs. 2321
Totala: 3729 vs. 3746
8 h postop:
Coll: 0 vs. 0
Cryst: 1528 vs. 1587
↓ Complications
→ ICU stay
→ LOS
↓ Lactate levels
Mortality: 2 (control) vs. 1 (GDT)
Challand et al. [59] Elective open or laparoscopic colorectal surgery 179 subdivided into: fit (123) vs. unfit (56)/ASA I-IV Observer blinded/ODM (CardioQ®)/intraoperative LOS Optimizing SV (<10 %) with HES 6 %, 130/0.4 (Voluven®) 971 vs. 1273
Hartmann’s solution
Coll: 336 vs. 1718
Cryst: 3593 vs. 3479
Totala: 4010 vs. 5309
1 postop. day:
Fluid balance: 2011 vs. 2083
Unfit patients:
→ LOS
→ Complications
Fit patients:
↑ LOS
↑ ICU admission
→ Complications
Mortality: d30: 2 (control) vs. 2 (GDT); d90: 4 (control) vs. 5 (GDT)
Salzwedel et al. [53] Elective general, urological, or gynecological 160/ASA II-III Patient blinded/ProAQT®, PULSION®/intraoperative Complications Optimizing PPV (<10 %) and CI (≥2.5 L/min/m2) with fluids, vasopressors and inotropes Not given Coll: 725 vs. 774
Cryst: 2680 vs. 2862
Total: not given
24 h postop.
Coll: 147 vs. 57
Cryst: 3452 vs. 3204
↓ Complications
→ LOS
→ Stay in postop. semi intensive care
→ Bowel movement
Mortality: not given
Pearse et al. [14] Planned/urgent GI surgery 734/ASA I-IV No blinding/LiDCOrapid®/intraoperative and 6 h postop. Complications and mortality d30 Optimizing SV (<10 %) with any colloid and dopexamine Not given Coll: 500 vs. 1250
Cryst: 2000 vs. 1000
Totalb: 4024 vs. 4190
Coll: 0 vs. 500
Cryst: 600 vs. 506
→ Mortality and complications d30
→ Complications d7
→ Mortality d30
Mortality: d30: 11 (control) vs. 12 (GDT); d180: 42 (control) vs. 28 (GDT)
  1. ICU intensive care unit, PONV postoperative nausea and vomiting, LOS length of hospital stay, ODM oesophageal Doppler monitoring, CI cardiac index, SV stroke volume, SVV stroke volume variation, SPV systolic pressure variation, PPV pulse pressure variation, PVI pleth variability index, cFT corrected flow time, CVP central venous pressure
  2. aTotal volume infused including colloid, crystalloid and blood products
  3. bTotal volume infused including colloid, crystalloid, blood products and intravenous medicine during intervention
  4. ↑significantly increased, ↓ significantly decreased, → no significant changes