Perioperative goal-directed hemodynamic therapy aims at optimizing global hemodynamics during the perioperative period by titrating fluids, vasopressors, and/or inotropes to reach predefined hemodynamic goals. Current evidence indicates that treating patients according to perioperative goal-directed hemodynamic therapy protocols reduces morbidity and mortality, particularly in patients having high-risk surgery. However, its adoption into clinical practice is still weak.

This strategy has also improved greatly over the past 40 years. Monitoring technology has evolved to enable very invasive devices to be replaced by much less invasive (and even totally non-invasive) equipment. Simultaneously, our whole approach to monitoring has shifted from using a few static, single measures to a functional, dynamic, and multivariable approach. Finally, we are moving from standard, protocolized hemodynamic strategies to a more personalized approach to ensure appropriate management of each patient. For this purpose, closed-loop systems are an appealing added value to ensure that therapies are delivered appropriately to all patients.