AANA August 2021 Journal Course: Perioperative Goal Directed Fluid Therapy: A Prime ERAS Component-Article

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Perioperative goal-directed fluid therapy (GDFT) is an important component of the Enhanced Recovery After Surgery (ERAS) protocol. GDFT has been shown to improve patient outcomes, including shorter hospital stays, reduced complications, and improved hemodynamic stability. The use of GDFT aims to maintain euvolemia and avoid both hypovolemia and hypervolemia. Carbohydrate loading, early discontinuation of intravenous fluids, and the use of balanced salt crystalloid solutions are key components of GDFT. Lactated Ringer's solution is recommended for nonrenal patients and those with hepatic compromise. GDFT strategies involve individualizing fluid therapy based on hemodynamic indicators such as heart rate, blood pressure, and central venous pressure. Intraoperative fluid management plays a crucial role in maintaining euvolemia. The ERAS protocol also includes considerations for fasting, carbohydrate loading, and the use of nasogastric tubes. While controversies exist, the literature largely supports the use of GDFT in the ERAS protocol to improve patient outcomes and shorten hospital stays. It is important for anesthesia providers to develop an individualized GDFT plan based on patient-specific factors and surgical requirements. However, further research is needed on postoperative fluid therapy within the ERAS protocol. The implementation of ERAS protocols may encounter resistance due to long-held beliefs and practices surrounding fasting and fluid management. Overall, GDFT plays a vital role in optimizing patient outcomes and speeding up the recovery process after surgery.

Keywords

GDFT

ERAS protocol

patient outcomes

euvolemia

carbohydrate loading

intravenous fluids

balanced salt crystalloid solutions

hemodynamic indicators

intraoperative fluid management

surgical requirements