Correspondence  |   March 2018
Volume Responsiveness Alone Is Not an Indication for Volume Administration!
Author Notes
  • University of Arizona, Phoenix, Arizona (J.A.B.). jbloomstone@cox.net
  • (Accepted for publication November 27, 2017.)
    (Accepted for publication November 27, 2017.)×
Article Information
Correspondence
Correspondence   |   March 2018
Volume Responsiveness Alone Is Not an Indication for Volume Administration!
Anesthesiology 3 2018, Vol.128, 681-682. doi:10.1097/ALN.0000000000002049
Anesthesiology 3 2018, Vol.128, 681-682. doi:10.1097/ALN.0000000000002049
It is with intrigue that we read Gómez-Izquierdo et al.’s paper demonstrating the lack of effectiveness of goal-directed fluid therapy (GDFT) in reducing ileus after elective laparoscopic colorectal surgery.1  We congratulate the authors for a well-done study and Anesthesiology for publishing an important negative trial. There are a few points we would like to discuss.
First, these authors join an increasingly large number of research groups whose results call into question the value of GDFT in mitigating complications and reducing hospital length of stay or cost after elective surgery. Specifically, several previous reports, and now that of Gómez-Izquierdo et al., collectively force us to critically examine the general applicability of GDFT in today’s surgical patients. Although GDFT has been shown to mitigate postsurgical complications in studies spanning three decades,2  its effectiveness in reducing postsurgical morbidity in patients on enhanced recovery pathways appears limited.3  Additionally, traditional proponents of GDFT recently have questioned its value within enhanced recovery.4,5  Even staunch proponents of standardized, best-evidence clinical pathway design and implementation have questioned the acceptance of all enhanced recovery elements without continued individual element evaluation.6,7  To be sure, the laparoscopic approach, avoidance of dehydrating bowel preparations, and clear liquid consumption until 2 h before surgery all play important roles in reducing the volume shifts that were typical of traditional surgical procedures. To these points, we agree with Gómez-Izquierdo et al. that important advancements in perioperative care have diminished the positive impact of GDFT.
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