Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy

Perioperative goal-directed haemodynamic therapy (GDHT) includes a variety of protocolised approaches to the assessment and management of the circulatory system and blood flow for patients undergoing surgery. Here we present updated consensus statements on perioperative GDHT developed during the 11th Perioperative Quality Initiative (POQI) consensus conference meeting held in London, UK in June, 2023. Statements relating to the definitions, components, and underlying physiology surrounding GDHT are proposed. We recommend considering use of GDHT in specific settings including during cardiopulmonary bypass (CPB), after cardiac surgery, and during hip fracture surgery. However, the level of evidence is weak in these settings. Clinicians can consider use of GDHT protocols on an individual patient basis for moderate- to high-risk patients undergoing major noncardiac surgery; however, we recommend against use of fixed low-dose inotrope infusions as part of GDHT protocols. We do not recommend routine use of GDHT protocols for patients undergoing major elective abdominal surgery. There is currently insufficient evidence to recommend routine use of GDHT during emergency abdominal surgery. Future research should focus on individualisation of GDHT to individual patients' haemodynamic requirements, newer paradigms such as technology-assisted delivery of GDHT protocols, and the role of predictive models using artificial intelligence.