A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. However, this approach has failed to achieve widespread adoption. Goal-directed fluid therapy (GDFT), aimed at optimizing flow-related variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. Perioperative fluid management - including the type, dose, and timing of administration -directly affects patient outcome after major surgery. There is no evidence of a benefit in using HES over crystalloid, despite its use resulting in a lower 24 h fluid balance.Clinical trial registrationISRCTN41882213 and EudraCT-2009-013872-29. Subjects in the crystalloid group received more fluid [median (inter-quartile ranges) 3175 (2000-3700) vs 1875 (1500-3000) ml, PGoal-directed fluid therapy is possible with either crystalloid or HES. st>No difference was seen in the number of patients who suffered GI morbidity on postoperative day 5. Secondary outcome measures included the incidence of postoperative complications, hospital length of stay, and the effect of trial fluids on coagulation and inflammation. The primary outcome measure was the incidence of gastrointestinal (GI) morbidity on postoperative day 5. st>We randomly assigned 202 medium to high-risk patients undergoing elective colorectal surgery to receive either balanced 6% HES (130/0.4, Volulyte) or balanced crystalloid (Hartmann's solution) as haemodynamic optimization fluid. Recent work has demonstrated that new generations of HES have a good safety profile, but their routine use in the perioperative setting has not been demonstrated to confer outcome benefit. Theoretical advantages of using hydroxyethyl starch (HES) for goal-directed therapy include a reduction in the total volume of fluid required, resulting in less tissue oedema. st>Goal-directed fluid therapy has been shown to improve outcomes after colorectal surgery, but the optimal type of i.v.
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