CVP 8-12 cmH2O Early use of mechanical ventilation
MAP 65-90 mmHg Fluid resuscitation
SvO2 >70% Use of vasoactive agents
ScvO2 >65% Noradrenaline
Urine output >0.5 ml/kg/h Dobutamine
Hematocrit >30% Transfusion
Goal-directed fluid therapy (GDFT), assessed by an optimized cardiac stroke volume, has been proposed as the “gold standard” for perioperative intravenous fluid therapy.
Despite numerous studies on perioperative intravenous fluid therapy, there is insufficient evidence to draw definitive conclusions regarding fluid management in neurosurgical patients. Although evidence is still lacking, isotonic balanced crystalloid solutions should be considered the first-choice fluid, while hypotonic solutions should be avoided. Furthermore, colloid solutions should be used with caution, and their potential risks and benefits should be considered. To achieve an optimal fluid volume status while avoiding overhydration and excessive restriction, the amount and duration of fluid administration should be considered, and an individualized fluid strategy is recommended using GDFT based on dynamic fluid parameters 1).
HES has been sometimes used to maintain an optimal volume status to prevent delayed cerebral ischemia (DCI) due to cerebral vasospasm following a subarachnoid hemorrhage (SAH) as a component of the triple H-therapy. Compared to the standard therapy group, the goal-directed fluid therapy (GDFT) with a HES bolus group showed reduced frequencies of vasospasm and cardiopulmonary complications 2).