We read with great interest the randomized controlled trial published recently by Joosten et al. in Anesthesiology. This study assessed the ability of a closed-loop system for the titration of a norepinephrine infusion combined with a fluid-management decision support system to decrease the percentage of intraoperative time at risk for tissue hypoperfusion when compared with a “traditional” manually controlled goal-directed hemodynamic optimization. The authors reported that patients in the computer-assisted group had significantly less total intraoperative time with hypotension (primary outcome), less oscillation in mean arterial pressure (MAP) during surgery, and a higher mean cardiac index at the end of the procedure—while also receiving less total norepinephrine by infusion and having a lower fluid balance.

We congratulate the authors for having performed such innovative research on perioperative hemodynamic optimization to improve patient’s postoperative outcome. Nonetheless, we have a few comments and questions.

Dr. Cholley has received honoraria...

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