GIFTASUP

The British Consensus Guidelines on Intravenous Therapy for Adult Surgery (GIFTASUP) were released in 2008, for dissemination to members of participating professional bodies. GIFTASUP states that a response in SV should be assessed using flow-based technology, intraoperative treatment can reduce complication rates and length of hospital stay and that postoperative monitoring should be carried out in non-elective abdominal and orthopedic surgery.

The guidelines were developed on behalf of BAPEN Medical, the Association for Clinical Biochemistry, the Association of Surgeons of Great Britain and Ireland, the Society of Academic and Research Surgery, the Renal Association and the Intensive Care Society. A total of 28 recommendations were made. Three recommendations relate directly to individualized fluid management, monitored using the flow-based parameters of the CardioQ-EDM+ monitor.

Each recommendation has been given an evidence level grade from 1-5, in accordance with the Oxford Centre for Evidence-Based Medicine, levels of evidence. A score of 1A represents the highest possible level of supporting clinical evidence.

Recommendation 12: When the diagnosis of hypovolemia is in doubt and the central venous pressure is not raised, the response to a bolus infusion of 200 ml of a suitable colloid or crystalloid should be tested. The response should be assessed using the patient’s cardiac output and stroke volume measured by flow-based technology if available. Alternatively, the clinical response may be monitored by measurement/estimation of the pulse, capillary refill, CVP and blood pressure before and 15 minutes after receiving the infusion. This procedure should be repeated until there is no further increase in stroke volume and improvement in the clinical parameters.
Evidence Level 1B – Flow-Based Measurements

Recommendation 13: In patients undergoing some forms of orthopedic and abdominal surgery, intraoperative treatment with intravenous fluid to achieve an optimal value of stroke volume should be used where possible as this may reduce postoperative complication rates and duration of hospital stay.
Evidence Level 1A – Abdominal Surgery
Evidence Level 1B – Orthopedic Surgery

Recommendation 14: Patients undergoing non-elective major abdominal or orthopedic surgery should receive intravenous fluid to achieve an optimal value of stroke volume during and for the first eight hours after surgery. This may be supplemented by a low dose of dopexamine infusion.
Evidence Level 1B