Haemodynamic management during major surgery

More than 300 million major surgeries are performed each year, but perioperative morbidity and mortality remains a problem for high risk surgeries.12 In 1988, a trial showed for the first time that a protocol involving inotropic infusions and fluid therapy could reduce mortality rates for high risk surgeries.3 The general concept was to improve oxygen delivery by achieving supranormal cardiac output with fluid loading and inotropic agents to reduce organ dysfunction and mortality. Numerous clinical studies subsequently found that haemodynamic goal directed therapy decreased postoperative morbidity.4 Despite national and international recommendations, however, monitoring of cardiac output is not well implemented for high risk surgeries owing to its complexity and invasiveness.56 One target could be to use a less invasive, user friendly device at the bedside. The linked study (doi:10.1136/bmj-2024-080439) evaluated such a strategy.7 OPTIMISE II was a large, multicentre, international randomised clinical trial designed to assess whether minimally invasive …