Development and Feasibility Study of an Algorithm for Intraoperative Goal-Directed Haemodynamic Management in Noncardiac Surgery

Abstract

This study developed an evidence-based, goal-directed haemodynamic management algorithm to standardize intraoperative haemodynamic therapy. A systematic literature search identified three haemodynamic management goals: stroke volume optimization by fluid therapy; maintenance of a target mean arterial pressure by vasopressor therapy; maintenance of a target cardiac index ≥ 2.5 l/min per m2 by inotropic therapy. The algorithm was adapted to international standards and consensus was reached through a modified Delphi method at international meetings. Implementation of the algorithm into routine intraoperative management in noncardiac surgery was shown to be feasible. Compared with conventional haemodynamic management, use of the algorithm significantly reduced length of hospital stay, requirement for ventilation and incidence of prolonged hospital stay, thereby resulting in reduced hospital costs.