Home > Journals > Minerva Anestesiologica > Past Issues > Minerva Anestesiologica 2020 December;86(12) > Minerva Anestesiologica 2020 December;86(12):1346-52



Publishing options
To subscribe
Submit an article
Recommend to your librarian


Publication history
Cite this article as


EXPERTS’ OPINION   Free accessfree

Minerva Anestesiologica 2020 December;86(12):1346-52

DOI: 10.23736/S0375-9393.20.14154-3


language: English

Can goal-directed fluid therapy decrease the use of blood and hemoderivates in surgical patients?

Dana R. TOMESCU 1, 2 , Ecaterina SCARLATESCU 2, Şerban I. BUBENEK-TURCONI 1, 3

1 Department of Anesthesia and Intensive Care, Fundeni Clinics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2 Third Department of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania; 3 First Department of Cardiovascular Anesthesiology and Intensive Care, Prof. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

The purpose of goal-directed therapy (GDT) is to improve patient outcome by the optimization of hemodynamic status, as it is considered that many perioperative complications are related to microcirculatory disturbance due to an imbalance between oxygen delivery and consumption. The application of GDT protocols incorporating the assessment and optimization of patients’ intravascular status should theoretically lead to a reduction in perioperative bleeding and transfusion requirements, as both hypervolemia and hypovolemia and their consequences such as dilutional coagulopathy, anemia and inadequate oxygen delivery to the tissues are avoided. However, the research reporting decreased usage of blood products in patients which received targeted fluid management is sparse; decreased blood loss and transfusion requirements were reported in spine surgery using GDT, while studies in abdominal or cardiac surgery did not consistently report significant decreases in blood products transfusion when GDT were applied. These heterogenous results reported can be explained by the differences between the GDT protocols used, as the differences in therapeutic goals can impact on blood transfusion requirements. In the future, the GDT protocols should include not only the prediction of fluid responsiveness and optimization of hemodynamic status, but also the assessment of microcirculation and measures to improve tissue oxygenation, parameters which can also guide the decision for blood product transfusion. A better standardization of GDT algorithms is also required in order to perform a more accurate assessment of the effects of applying GDT on the consumption of blood products.

KEY WORDS: Goal-directed therapy; Hemodynamics; Blood transfusion

top of page