BEACH

The main focus of the working group is to create algorithms to guide volume, fluid and catecholamine therapy and to evaluate their clinical impact on perioperative care of our patients. The relevance for the surgical patient of preload optimization using the oesophageal Doppler is shown in several studies. The oesophageal Doppler represents a minimal-invasive method to monitor hemodynamic parameters and was used within a targeted-volume protocol, which led to reduced length of stay and decreased morbidity.

The standardization of the mean arterial pressure and cardiac index and the integration with preload optimization into a clinical algorithm is the next step to achieve circulatory homeostasis. The impact of the algorithm on outcome and the perioperative course of the patient is one of the main goals of the working group by randomized controlled studies. A special focus is to investigate the influence of the goal-directed hemodynamic therapy on delirium and the cognitive function of the patients as these factors are key elements to influence quality of life after a surgical procedure.

The standardized goal-directed algorithm offers the possibility to investigate the effects of crystalloid and colloid solutions for volume replacement in perioperative patients. The aim of the perioperative volume therapy is the maintenance or recovery of the intravascular normovolemia without expansion of the interstitial space. Crystalloids stay only for ¼ intravascular and expand the interstitial space. On the other hand during normovolemia or slight hypovolemia starch solutions have an intravascular volume effect of 100 % without expansion of the interstitial space and without causing edema. There are hints of different organ dysfunctions after either of these fluids. On one hand current evidence indicates that using crystalloids exclusively may cause overloading of the interstitial compartment with considerable negative sequelae, whereas using colloids may improve microperfusion and tissue oxygenation. On the other hand colloids have a potential to reduce renal function if overdosed. The role is unclear in hypovolemic and hypervolemic states. In particular, "dry" states can occur in orthopedic hip surgery, often seen in elderly patients.