Implementation and Compliance with a Goal-Directed Fluid Therapy (GDFT) Protocol for Total Hip Arthroplasties: A Two-Year Review

Background: Historically, goal-directed fluid therapy (GDFT) has been shown to improve patient outcomes when used in the perioperative setting for specific cases (colorectal, etc). When anesthesia providers use GDFT protocols, intraoperative fluid therapy is” patient specific” via the use of dynamic patient-specific physiologic parameters.

Objectives: The aim of the study is to assess whether GDFT improved patient-specific fluid administration. A secondary aim was to assess adherence to the instated GDFT protocol.

Method: A retrospective chart review was conducted on 201 patients undergoing total hip arthroplasty (THA) procedures following implementation of a GDFT protocol at the University of Illinois at Chicago Hospital.

Results: The compliant group consisted of older, heavier, sicker (higher ASA score) patients whom had more EBL during surgery. The compliant group showed a moderate-strong positive correlation between fluid output and fluid administration (r=0.664), while the group that did not utilize the EV-1000™ monitor and GDFT protocol had a weaker linear relationship (r=0.373). When the protocol was used, practitioners were compliant in over 50 percent of cases for over 70 percent of the surgical time.

Conclusion: Trends suggest improved patient-specific precision of fluid administration when a GDFT protocol is used. Further evaluations of a GDFT for THA procedures should be conducted for increased protocol validity