Goal Directed Fluid Therapy

General Goals

1. Map > 65
2. SVI > 35
3. CI > 2.5

Hypoperfusion Signs/Symptoms

1. Hypotension
2. Low/Decreasing SVI
3. Metabolic Acidosis (base deficit or low HCO3)
4. Increasing PPV
5. Oliguria

Goal Directed Fluid Therapy in the OR

1. Baseline fluids: 3-5cc/kg/hr
2. Evidence for hypoperfusion?
   • No: No further intervention
   • Yes:
     • Is the patient fluid responsive?
     • Baseline SVI or PPV
     • Give 250-500cc over 10min
     • Does the SVI/PPV increase/decrease by 10%?
       • Yes: Patient is fluid responsive
         • Reassess
         • Rebolus if needed
         • Consider vasopressor bolus vs drip
         • After 1-2L of crystalloid switch to 5% albumin
       • No: Patient is not fluid responsive
         • Consider vasopressors/inotropes
         • Consider increased monitoring such as PA catheter or TEE

PPV Checklist

1. NSR
2. 8-10cc/kg tidal volume in assist control not AF or PC or PS
3. No spontaneous breaths
4. No RV failure
5. Low intraabdominal pressures in laproscopic surgery
6. No prone spine case
7. No thoracic or one lung/open chest case
8. EF > 45%
9. No over/under dampened arterial line

Is The Arterial Line Dampened?