Newly Published
Editorial  |   April 2020
Goal-directed Therapy: Why Benefit Remains Uncertain
Author Notes
  • From the Departments of General Anesthesiology (K.M.) and Outcomes Research (K.M., D.I.S.), Cleveland Clinic, Cleveland, Ohio.
  • Accepted for publication March 20, 2020.
    Accepted for publication March 20, 2020.×
  • Corresponding article on page XXX.
    Corresponding article on page XXX.×
  • Correspondence: Address correspondence to Dr. Maheshwari:
Article Information
Editorial / Cardiovascular Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Editorial   |   April 2020
Goal-directed Therapy: Why Benefit Remains Uncertain
Anesthesiology Newly Published on April 28, 2020. doi:
Anesthesiology Newly Published on April 28, 2020. doi:
The aim of goal-directed therapy or guided fluid management or individualized fluid management is to maximize oxygen delivery to sensitive tissues by optimizing cardiac output. The underlying basis for all guided fluid management is that optimal vascular volume improves cardiac output, with “optimal” being defined as sufficient volume to bring patients toward the top of the Frank Starling preload-stroke volume curve. In this issue of Anesthesiology, Fischer et al.1  report randomizing 447 intermediate-risk orthopedic surgical patients to routine fluid management or fluid administration guided by the plethysmographic variability index in five French hospitals (the Optimization using the Pleth Variability Index [OPVI] Trial). In patients assigned to guided management, boluses of the colloid Gelofusion 6% were given to keep the plethysmographic variability index less than 13%. Patients received significantly larger amounts of cumulative fluid in the guided management group, 1,088 ± 606 ml versus 677 ± 608 ml in the control group. The primary outcome, postoperative hospital length of stay, was similar (6 ± 3 days) in both groups, as were the secondary outcomes including postoperative complications. The authors concluded that plethysmographic variability index–guided fluid management does not shorten the duration of hospitalization or reduce complications.1