Individualised Perioperative Blood Pressure and Fluid Therapy in Oesophagectomy a prospective, single-blind randomised controlled trial

Background: Oesophagectomy is a key treatment for oesophageal cancer but carries a high risk of postoperative complications, some potentially preventable through optimised haemodynamic management. Goal-directed fluid therapy individualises cardiac output targets but often applies fixed blood pressure thresholds and is discontinued before major postoperative fluid shifts occur. Extending goal-directed fluid therapy into the postoperative period with individualised blood pressure thresholds may address these limitations. Methods: In this single-centre, prospective, blinded, randomised controlled trial, patients undergoing oesophagectomy were randomised 1:1 to either extended goal-directed fluid therapy or standard care. In the extended goal-directed fluid therapy group, cardiac output was optimised and mean arterial pressure threshold was the individual patient's night-time baseline. The protocol continued from tracheal intubation through to 07:00 the following morning. The primary outcome was total postoperative morbidity, measured by the Comprehensive Complication Index at day 30. Results: Of 100 patients (49 extended goal-directed fluid therapy group, 51 standard group), extended goal-directed fluid therapy was associated with a higher fluid balance (2,517 ± 1,194 mL vs 2,001 ± 1,114 mL, mean difference: 516 mL, 95% CI: 57 - 974, p = 0.028), increased norepinephrine use (median: 7,894 μg [IQR: 3,946–13,793] vs 4,611 μg [IQR: 2,138–7,296], p < 0.001), and higher mean arterial pressure (mean difference: 3 mmHg, 95% CI: 1–5, p = 0.011). At day 30, mean Comprehensive Complication Index did not differ between groups (39.0 ± 20.0 vs 39.2 ± 21.0; mean difference: –0.2; 95% CI: –8.6 to 8.1; p = 0.95). Conclusion: Despite achieving protocol-driven treatment differences, extended and individualised goal-directed fluid therapy did not reduce postoperative complications following oesophagectomy.