Perioperative optimisation of fluid management improves outcome

Mortality from high-risk surgery is close to 10% (20% with emergency). Poor outcome is linked to tissue hypoperfusion. Optimising fluid therapy has a good pathophysiological basis related to microvascular flow to the tissues and the risk of multiple organ failure. Metaanalysis showed the higher the risk of surgery the greater the benefit of fluid and flow optimisation. A direct technique (blood pressure is indirect) to manage fluid therapy measuring tissues perfusions has not yet fulfilled criteria (easiness, accuracy, less invasiveness). At present pulmonary artery catheter with continuous output measurement is the choice. The aim of the study is to assess the impact of fluid management to increase blood flow in high-risk surgical patient.