Effect of Using Trans-Esophageal Echocardiography Guided Goal-Directed Hemodynamic Therapy compared to Conventional Hemodynamic Management in Reducing Post-Operative Pulmonary Complications in Elective Major Open Abdominal Surgery under General Anesthesia: Review Article

Background: Morbidity after major abdominal surgery is substantial. More than 20% of patients suffer from postoperative complications that require invasive treatment and substantially increase the risk of further morbidity and mortality. Apart from surgical morbidity, non-surgical complications represent a significant proportion of postoperative complications. Cardiopulmonary adverse events account for up to 50% of postoperative complications in upper abdominal operations. 
Objective: This article aimed to throw the light on how to reduce incidence of post-operative pulmonary complications (PPCs) after major abdominal surgery.
Material and methods: We searched Google Scholar, Science Direct, PubMed and other online databases for Trans-esophageal echocardiography guided goal-directed, Conventional hemodynamic management, Post-operative cardiopulmonary complications. The authors also reviewed references from pertinent literature, however only the most recent or comprehensive studies from 2010 to February 2023 were included. Documents in languages other than English were disqualified due to lack of translation-related sources. Papers such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations that were not part of larger scientific studies were excluded.
Conclusion: Pulmonary complications lead to significantly increased morbidity, mortality, and length of hospital stay, especially after major upper abdominal surgery. A large variety of cardiac output (CO) monitoring devices are currently offered today that claim to allow for perioperative hemodynamic optimization. These technologies have rapidly evolved from very invasive to mini-invasive and even completely noninvasive devices. The first step for proper goal-directed therapy (GDT) implementation in the operating room (OR) is to identify the patient’s surgical risk and to determine appropriate vascular access. Once established, one can choose the best available monitoring approach and the suitable hemodynamic optimization protocol.