Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis

Within the field of Enhanced Recovery after Thoracic and Cardiac Surgery (ERATS and ERACS, respectively), appropriate  fluid administration that avoids the detrimental effects of tissue edema on organ function and wound healing is a potentially important modifier of postoperative outcomes. This use of specific hemodynamic and other targets to provide goals of administered fluids (i.e. goal-directed therapy or GDT) has been suggested as an effective means to provide sufficient volume to facilitate cardiac flow while minimizing the potential harms of excessive fluid resuscitation.  The literature to this point, however, has been inconsistent in demonstrating improvements in clinical outcomes.  Bednarczyk and colleagues have undertaken an important and well-constructed SR/MA to determine if acute volume resuscitation using an objective measure of fluid responsiveness (stroke volume variation, pulse pressure variation, and stroke volume change with passive leg raise/fluid challenge) is associated with improved outcomes. In this analysis, the authors have concluded that the use of GDT guided assessments of fluid responsiveness was associated with reduced mortality, ICU length of stay, and time on mechanical ventilation. Further high quality clinical investigation in the cardiac critical care environment is warranted.