Goal-directed Therapy and Postcystectomy Ileus: Comment

We read with interest the recently published study by Arslan-Carlon et al. in Anesthesiology.¹  This primary objective of this randomized, controlled trial (N = 283) was to determine whether a goal-directed fluid therapy approach would result in a lower incidence of postoperative ileus compared with a standard fluid therapy approach in patients undergoing open radical cystectomy. All patients had an arterial line coupled to an advanced hemodynamic monitoring device (EV-1000, Edwards Lifesciences, USA) to monitor advanced hemodynamic variables before, during, and immediately after surgery. No statistically significant difference in this primary outcome was found between the two groups. Interestingly, however, the authors identified a relative negative impact of goal-directed fluid therapy on acute kidney injury (AKI) incidence (secondary outcome) with more patients in the goal-directed fluid therapy group who experienced AKI (56% vs. 40%,...