The aim of this study was to review recent advances and evidence for the use of cardiac output monitors to guide perioperative haemodynamic therapy.
There are multiple different cardiac output monitoring devices available for clinical use which are coupled with many different intervention protocols to manipulate perioperative haemodynamics. There is little evidence to demonstrate superiority of any one device. Previous small studies and meta-analyses have suggested that perioperative haemodynamic therapy guided by cardiac output monitoring improves outcomes after major surgery. Despite relatively low-quality evidence several national bodies have recommended ‘perioperative goal-directed therapy’ (GDT) as a standard of care.
Recent larger trials of GDT have mostly failed to prove a benefit of GDT and one explanation for this is the increased quality of usual care that may be occurring because of initiatives such as enhanced recovery after surgery and the WHO Safer Surgery programmes.
Perioperative GDT remains an exciting intervention to reduce significant morbidity following major surgery; however, it is not yet a proven standard of care. Further large pragmatic trials are required to demonstrate its effectiveness particularly in the era of enhanced recovery after surgery programmes.
aCardiothoracic and Vascular ICU, Auckland City Hospital, Auckland
bMedical Research Institute of New Zealand, Wellington, New Zealand
cAustralia and New Zealand Intensive Care Research Centre, School of Epidemiology and Public Health, Monash University, Melbourne, Australia
dFaculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
Correspondence to Dr Shay McGuinness, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Park Road, Grafton, Auckland 1140, New Zealand. Tel: +64 9 3074949/24489