***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The use of adequate fluid therapy during  cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC )  remains controversial . The aim of the study was to assess whether the use of fluid therapy protocol combined with goal -directed therapy ( GDT ) is associated with a significant change in morbidity , length of hospital stay , and mortality compared to st and ard fluid therapy . Patients American Society of Anesthesiologists ( ASA ) II – III undergoing CRS and HIPEC were r and omized into two groups . The GDT group ( N = 38 ) received fluid therapy according to a protocol guided by monitored hemodynamic parameters . The control group ( N = 42 ) received st and ard fluid therapy . We evaluated incidence of major complications , total length of hospital stay , total amount of fluids administered , and mortality rate . The incidence of major abdominal complications was 10.5 % in GDT group and 38.1 % in the control group ( P = 0.005 ) . The median duration of hospitalization was 19 days in GDT group and 29 days in the control group ( P < 0.0001 ) . The mortality rate was zero in GDT group vs 9.5 % in the control group ( P = 0.12 ) . GDT group received a significantly ( P < 0.0001 ) lower amount of fluid ( 5812 ± 1244 ml ) than the control group ( 8269 ± 1452 ml ) , with a significantly ( P < 0.0001 ) lower volume of crystalloids ( 3884 ± 1003 vs 68,528 ± 1413 ml ) . In CRS and HIPEC , the use of a GDT improves outcome in terms of incidence of major abdominal and systemic postoperative complications and length of hospital stay , compared to st and ard fluid therapy protocol BACKGROUND Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality . METHODS We performed a r and omized trial comparing goal -directed therapy guided by a pulmonary-artery catheter with st and ard care without the use of a pulmonary-artery catheter . The subjects were high-risk patients 60 years of age or older , with American Society of Anesthesiologists ( ASA ) class III or IV risk , who were scheduled for urgent or elective major surgery , followed by a stay in an intensive care unit . Outcomes were adjudicated by observers who were unaware of the treatment-group assignments . The primary outcome was in-hospital mortality from any cause . RESULTS Of 3803 eligible patients , 1994 ( 52.4 percent ) underwent r and omization . The base-line characteristics of the two treatment groups were similar . A total of 77 of 997 patients who underwent surgery without the use of a  pulmonary-artery catheter ( 7.7 percent ) died in the hospital , as compared with 78 of 997 patients in whom a pulmonary-artery catheter was used ( 7.8 percent)--a difference of 0.1 percentage point ( 95 percent confidence interval , -2.3 to 2.5 ) . There was a higher rate of pulmonary embolism in the catheter group than in the st and ard-care group ( 8 events vs. 0 events , P=0.004 ) . The survival rates at 6 months among patients in the st and ard-care and catheter groups were 88.1 and 87.4 percent , respectively ( difference , -0.7 percentage point [ 95 percent confidence interval , -3.6 to 2.2 ] ; negative survival differences favor st and ard care ) ; at 12 months , the rates were 83.9 and 83.0 percent , respectively ( difference , -0.9 percentage point [ 95 percent confidence interval , -4.3 to 2.4 ] ) . The median hospital stay was 10 days in each group . CONCLUSIONS We found no benefit to therapy directed by pulmonary-artery catheter over st and ard care in elderly , high-risk surgical patients requiring intensive care Introduction Several studies have shown that goal -directed hemodynamic and fluid optimization may result in improved outcome . However , the methods used were either invasive or had other limitations . The aim of this study was to perform intraoperative goal -directed therapy with a minimally invasive , easy to use device ( FloTrac/Vigileo ) , and to evaluate possible improvements in patient outcome determined by the duration of hospital stay and the incidence of complications compared to a st and ard management protocol . Methods In this r and omized , controlled trial 60 high-risk patients scheduled for major abdominal surgery were included . Patients were allocated into either an enhanced hemodynamic monitoring group using a cardiac index based intraoperative optimization protocol ( FloTrac/Vigileo device , GDT-group , n = 30 ) or a st and ard management group ( Control-group , n = 30 ) , based on st and ard monitoring data . Results The median duration of hospital stay was significantly reduced in the GDT-group with 15 ( 12 - 17.75 ) days versus 19 ( 14 - 23.5 ) days ( P = 0.006 ) and fewer patients developed complications than in the Control-group [ 6 patients ( 20 % ) versus 15 patients ( 50 % ) , P = 0.03 ] . The total number of complications was reduced in the GDT-group ( 17 versus 49 complications , P = 0.001 ) . Conclusions In high-risk patients undergoing major abdominal surgery , implementation of an intraoperative goal -directed hemodynamic optimization protocol using the FloTrac/Vigileo device was associated with a reduced length of hospital stay and a lower incidence of complications compared to a st and ard management protocol .Trial Registration Clinical trial registration information : Unique identifier : The objective was to compare the impact of an early goal -directed hemodynamic therapy based on cardiac output monitoring ( Endotracheal Cardiac Output Monitor , ECOM ) with a st and ard of care on postoperative outcome following coronary surgery . This prospect i ve , controlled , parallel-arm trial r and omized 100 elective primary coronary artery bypass grafting patients to a study group ( ECOM ; n = 50 ) or a  control group  ( control ; n = 50 ) . In the ECOM group , hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system . A st and ard of care was used in the control . Goal -directed therapy was started immediately after induction of anesthesia and continued until arrival in the intensive care unit ( ICU ) . The primary endpoint was the time when patients fulfilled discharge criteria from hospital ( possible hospital discharge ) . Secondary endpoints were the hospital discharge , the time to reach extubation , the length of stay in ICU , the number of major adverse cardiac events , and in-hospital mortality . Patients in the ECOM group received more often fluid loading and dobutamine . The time to reach extubation was reduced in the ECOM group : 510 min [ 360–1,110 ] versus 570 min [ 320–1,520 ] , P = 0.005 . No significant differences were found between both groups for possible hospital discharge [ Hazard Ratio = 0.96 ( 95 % CI 0.64–1.45 ) ] and hospital discharge [ Hazard Ratio = 1.20 ( 95 % CI 0.79–1.81 ) ] . A mini-invasive early goal -directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity Background and Aims : Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients . We aim ed to assess the impact of goal directed therapy ( GDT ) targeting cardiac index ( CI ) and oxygen extraction ratio ( O 2 ER ) on outcomes of high-risk patients undergoing abdominal surgery . Methods : In a prospect i ve r and omised trial , forty patients ( American Society of Anaesthesiologists II and III ) undergoing major abdominal surgeries  were r and omised into two groups . In-Group A mean arterial pressure ≥ 65 mmHg , central venous pressure ≥ 8 - 10 mmHg , urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70 % were targeted intra-operatively and 12 h postoperatively . In-Group-B ( enhanced GDT ) , in addition to the monitoring in-Group-A , CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27 % were targeted . The end-points were lactate levels and base deficit during and after surgery . The secondary end points were length of Intensive Care Unit ( ICU ) and hospital stay and postoperative complications . Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment . Results : Lactate levels postoperatively at 4 and 8 h were lower in-Group-B ( P < 0.05 ) . The mean base deficit at 3 , 4 , 5 and 6 h intra-operatively and postoperatively after 4 , 8 and 12 h were lower in-Group-B ( P < 0.05 ) . There were no significant differences in ICU stay ( 2.10 ± 1.52 vs. 2.90 ± 2.51 days ) or hospital stay ( 10.85 + 4.39 vs. 13.35 + 6.77 days ) between Group A and B. Conclusions : Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation Background The use of goal directed fluid protocol s in intermediate risk patients undergoing hip or knee replacement was studied in few trials using invasive monitoring . For this reason we have implemented two different fluid management protocol s , both based on a novel totally non-invasive arterial pressure monitoring device and compared them to the st and ard ( no- protocol ) treatment applied before the transition in our academic institution . Methods Three treatment groups were compared in this prospect i ve study : the observational ( CONTROL , N = 40 ) group before adoption of fluid protocol s  and two r and omized groups after the transition to protocol fluid management with the use of the continuous non-invasive blood pressure monitoring ( CNAP ® ) device . In the PRESSURE group ( N = 40 ) st and ard variables were used for restrictive fluid therapy . Goal directed fluid therapy using pulse pressure variation was used in the GDFT arm ( N = 40 ) . The influence on the rate of postoperative complications , on the hospital length of stay and other parameters was assessed . Results Both protocol s were associated with decreased fluid administration and maintained hemodynamic stability . Reduced rate of postoperative infection and organ complications ( 22 ( 55 % ) vs. 33 ( 83 % ) patients ; p = 0.016 ; relative risk 0.67 ( 0.49–0.91 ) ) was observed in the GDFT group compared to CONTROL . Lower number of patients receiving transfusion ( 4 ( 10 % ) in GDFT vs. 17 ( 43 % ) in CONTROL ; p = 0.005 ) might contribute to this observation . No significant differences were observed in other end-points . Conclusion In our study , the use of the fluid protocol based on pulse pressure variation assessed using continuous non-invasive arterial pressure measurement seems to be associated with a reduction in postoperative complications and transfusion needs as compared to st and ard no- protocol treatment . Trial registration Background Major abdominal surgery is associated with significant risk of morbidity and mortality in the perioperative period . Optimising intraoperative fluid administration may result in improved outcomes . Our aim was to compare the effects of central venous pressure ( CVP ) , and central venous oxygen saturation (ScvO2)-assisted fluid therapy on postoperative complications in patients undergoing high risk surgery . Methods Patients undergoing elective major abdominal surgery were r and omised into  control and ScvO2  groups . The target level of mean arterial pressure ( MAP ) was ≥ 60 mmHg in both groups . In cases of MAP < 60 mmHg patients received either a fluid or vasopressor bolus according to the CVP < 8 mmHg in the control group . In the ScvO2 group , in addition to the MAP , an ScvO2 of < 75 % or a > 3 % decrease indicated need for intervention , regardless of the actual MAP . Data are presented as mean ± st and ard deviation or median ( interquartile range ) . Results We observed a lower number of patients with complications in the ScvO2 group compared to the control group , however it did not reach statistical significance ( ScvO2 group : 10 vs. control group : 19 ; p = 0.07 ) . Patients in the ScvO2 group ( n = 38 ) received more colloids compared to the control group ( n = 41 ) [ 279(161 ) vs. 107(250 ) ml/h ; p < 0.001 ] . Both groups received similar amounts of crystalloid ( 1126 ± 471 vs. 1049 ± 431 ml/h ; p = 0.46 ) and norepinephrine [ 37(107 ) vs. 18(73 ) mcg/h ; p = 0.84 ] . Despite similar blood loss in both groups , the ScvO2 group received more blood transfusions ( 63 % vs. 37 % ; p = 0.018 ) . More patients in the control group had a postoperative PaO2/FiO2 < 200 mmHg (  
    Output:
    
In subgroup analysis , there was no mortality benefit for fluid-only goal -directed therapy , cardiac surgery patients or nonelective surgery .
Peri-operative modern goal -directed therapy  reduces morbidity and mortality .