REVIEW ARTICLE
HEMODYNAMIC MONITORING AND GOAL-DIRECTED THERAPY IN MAJOR ABDOMINAL SURGERY: CURRENT CONCEPTS AND FUTURE DIRECTIONS

UDK: 616.3-089:616.15

www.doi.org/10.67214/dwrdp339

Sulejmani H.,1 Jovanovski-Srceva M.1,2, Brzanov N.1,2, Bozinovska M.3 , Gavrilovska-Brzanov A.1,2

1Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia

2University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care, and Emergency Medicine, Skopje, North Macedonia; Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia

3Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia

Abstract

Objective: Major abdominal surgery is frequently associated with substantial physiological stress, fluid shifts, inflammatory activation, and perioperative hemodynamic instability, all of which may contribute to postoperative organ dysfunction and increased morbidity.

Over recent decades, perioperative hemodynamic management has evolved from reliance on static physiological variables toward individualized, physiology-driven optimization strategies.

Materials and Methods: This narrative review summarizes current concepts in perioperative hemodynamic monitoring and GDT in major abdominal surgery. The physiological basis of tissue perfusion, preload responsiveness, and cardiovascular optimization is discussed together with the clinical role of static and dynamic monitoring variables, including mean arterial pressure, central venous pressure, lactate, pulse pressure variation, stroke volume variation, and passive leg raising. Contemporary monitoring technologies such as arterial waveform analysis, minimally invasive cardiac output monitoring, and perioperative echocardiography are also reviewed.

Discussion: Contemporary perioperative medicine increasingly integrates dynamic hemodynamic monitoring, minimally invasive cardiac output assessment, arterial waveform analysis, ultrasound-based evaluation, and goal-directed therapy (GDT) protocols to optimize tissue perfusion while avoiding both hypovolemia and fluid overload.
Current evidence suggests that individualized GDT strategies integrating fluids, vasopressors, and inotropic therapy may reduce postoperative complications, shorten hospital stay, and optimize perioperative outcomes in selected abdominal surgery populations. Emerging technologies including artificial intelligence, predictive analytics, and machine learning-assisted monitoring systems may further transform future perioperative management through precision-based physiological optimization.

Conclusion: Current evidence suggests that individualized GDT strategies integrating fluids, vasopressors, and inotropic therapy may reduce postoperative complications, shorten hospital stay, and optimize perioperative outcomes in selected abdominal surgery populations.

Keywords: Dynamic hemodynamic monitoring; fluid responsiveness; goal-directed therapy; hemodynamic monitoring; major abdominal surgery; perioperative medicine.

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