Hemodynamic monitoring and goal-directed fluid management in abdominal surgery

This thesis focused on the perioperative practices for elective medium-to-high-risk abdominal surgery and the variation within them. Although mortality rates have decreased over the years, complication rates remain high and are a significant burden for patients and society, both in the short and long term. To mitigate these unfavorable outcomes, preoperative risk assessments, intraoperative optimization strategies and postoperative complication assessments are commonly implemented. Intraoperative optimization specifically aims to improve the patient’s perioperative hemodynamic condition using fluids, vasopressors and inotropes. Hemodynamic guidance can be performed by a gold standard device, although less invasive devices with mandatory adequate accuracy and precision have become more relevant for clinical applicability. Despite these interventions, frailty remains a factor responsible for the significant burden of postoperative complications, particularly when these complications remain unidentified and result in a higher mortality rate; a situation called failure-to-rescue. This thesis highlighted the role of standardization and hemodynamic optimization using goal-directed therapy (GDT) for the detection and treatment of hemodynamic disturbances.