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We read with great interest the recent study by Lobo and colleagues stating that fluid restriction during optimization of oxygen delivery (DO2) using dobutamine improves patient outcome after major surgery. Previous studies have shown that haemodynamic optimization using either an individualized goal-directed fluid substitution or inotrope to maximize DO2 reduces postoperative morbidity and hospital length of stay. Although the study brings important new insights, we believe however that some limits should be pointed.

Optimization of oxygen delivery during high-risk surgery: keeping the concept but refining goals for inotrope infusion?