November 29, 2025
Background: Goal-directed haemodynamic therapy (GDHT) has long been advocated to optimize tissue perfusion and improve postoperative outcomes. However, recent evidence has questioned its routine use across all surgical populations. Using the GRADE framework and a modified Delphi process, the Perioperative Quality Initiative (POQI) group developed an updated international consensus statement on GDHT.
Recommendations: An international panel of experts in perioperative haemodynamic management reviewed the available evidence and formulated consensus recommendations. The panel does not recommend routine use of goal-directed haemodynamic therapy for patients undergoing major abdominal surgery or the routine use of fixed low-dose inotrope infusions. Instead, GDHT is recommended only in selected clinical settings, including during cardiopulmonary bypass, after cardiac surgery, and in patients undergoing hip fracture surgery. These recommendations are based on low-certainty evidence.
Conclusions: The updated POQI consensus supports a more selective, individualized approach to goal-directed haemodynamic therapy rather than its routine application in all major surgical patients. The recommendations also highlight important knowledge gaps and provide direction for future perioperative research.
Keywords: cardiac output; fluid therapy; goal-directed haemodynamic therapy; inotropes; perioperative medicine.
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