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Open Access Highly Accessed Research article

Goal-directed fluid therapy- a survey of anaesthetists in the UK, USA, Australia and New Zealand

Sanket Srinivasa1*, Arman Kahokehr1, Mattias Soop2, Matthew Taylor3 and Andrew G Hill1

Author Affiliations

1 Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand

2 Department of Surgery, North Shore Hospital, University of Auckland, Auckland, New Zealand

3 Department of Anaesthesia, Middlemore Hospital, Auckland, New Zealand

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BMC Anesthesiology 2013, 13:5  doi:10.1186/1471-2253-13-5

Published: 22 February 2013

Abstract

Background

Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery. However, there has been no assessment regarding its use in clinical practice.

Methods

An electronic survey was administered to randomly selected anaesthetists from the United Kingdom (UK, n = 2000) and the United States of America (USA, n = 2000), and 500 anaesthetists from Australia/New Zealand (AUS/NZ). Preferences, clinical use and attitudes towards GDFT were investigated. Results were collated to examine regional differences.

Results

The response rates from the UK (n = 708) and AUS/NZ (n = 180) were 35%, and 36% respectively. The response rate from the USA was very low (n = 178; 9%). GDFT use was significantly more common in the UK than in AUS/NZ (p < 0.01). The Oesophageal Doppler Monitor was the most preferred instrument in the UK (n = 362; h76%) with no clear preferences in other regions. GDFT was most commonly utilised in major abdominal surgery and for patients with significant comorbidities. The commonest reasons stated for not using GDFT were either lack of availability of monitoring tools (AUS/NZ: 57 (70%); UK: 94 (64%)) or a lack of experience with instruments (AUS/NZ: 43 (53%); UK: 51 (35%)). A subset of respondents (AUS/NZ: 22(27%); UK: 45 (30%)) felt GDFT provided no perceived benefit. Enthusiasm towards the use of GDFT in the absence of existing barriers was high.

Conclusion

Several hypotheses were generated regarding important differences in the use of GDFT between anaesthetists from the UK and AUS/NZ. There is significant interest in utilising GDFT in clinical practice and existing barriers should be addressed.

Keywords:
Intravenous fluid; Goal-directed fluid therapy; Perioperative care; Surgery