Figure 5.

Peri-operative fluid and hemodynamic management for esophagectomy. Fluid strategy and hemodynamic approach consider the patient’s anesthesiological peri-operative risk and the risk of surgery itself. For low-risk patients undergoing low risk surgery, standard monitoring and a liberal fluid strategy (green triangles) are considered a valuable option. Esophagectomy should be considered an intermediate-high risk surgery. Consequently, “zero balance” (light blue triangles) or GDT (blue triangles) approach are the proposed options: the former should be considered if the patient is at low-intermediate risk, the latter when a high-risk patient will face to esophagectomy. Hemodynamic monitoring is also included in the figure: patient at low-intermediate risk would benefit from mini-invasive approach, high-risk patients need more invasive tools. HR, heart rate; NIBP, non-invasive arterial blood pressure; IAP, invasive arterial blood pressure; SVV, stroke volume variation; PPV, pulse pressure variation; ScVO₂, central venous oxygen saturation; SVI, stroke volume index; CI, cardiac index; DO₂I, indexed oxygen delivery; GDT, goal directed fluid therapy.