Faculty Collaboration Database

Hemodynamic coherence in 2025: A year in review from the Fluid Therapy and Hemodynamic Group of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR). Rev Esp Anestesiol Reanim (Engl Ed) 2026 Apr;73(4):502090

Date

03/24/2026

Pubmed ID

41871805

DOI

10.1016/j.redare.2026.502090

Abstract

BACKGROUND: Haemodynamic research advanced across perioperative and critical-care medicine, with major contributions in vascular physiology, microcirculation, fluid therapy, arterial pressure targets, organ protection and the clinical performance of monitoring and artificial intelligence (AI) supported systems. Given the breadth and heterogeneity of this evidence, a coherent physiological synthesis is required.

METHODS: Between December 2024 and December 2025, we undertook a broad, intentionally inclusive review of high-impact perioperative and critical-care journals, complemented by targeted PubMed searches centred on perfusion, arterial pressure, microcirculation and haemodynamic monitoring in adult patients. Selection was curatorial rather than exhaustive, optimization studies that materially advanced physiological understanding or challenged prevailing assumptions. Relevant trials, mechanistic studies and conceptual papers were grouped into thematic blocks and interpreted through a unified physiological lens. No formal risk-of-bias scoring was applied.

FINDINGS: Macrocirculatory correction alone did not ensure microvascular or metabolic recovery. Vasoplegia, endothelial dysfunction and venous congestion repeatedly defined the limits of resuscitation, while vasopressor efficacy proved phenotype-dependent. Timing of fluid administration outweighed cumulative volume, and early-perfusion markers outperformed traditional surrogates such as lactate. Intraoperative blood pressure prediction and automation consistently reduced hypotension exposure but did not improve organ injury or complications. Renal protection advanced through biomarker-enriched prevention rather than numerical thresholds. Updated guidelines emphasised physiological coherence over fixed targets, highlighting persisting uncertainty around personalised arterial pressure goals, optimal perfusion monitoring and the integration of emerging AI systems.

CONCLUSION: The 2025 haemodynamic literature reinforces a unifying principle: numerical optimization is insufficient; clinical benefit arises only when interventions respect vascular biology, microcirculatory capacity and metabolic tolerance.

Author List

Ripollés-Melchor J, Espinosa ÁV, Monge-García MI, Colomina MJ, Galán-Menéndez P, Yanes-Vidal G, Navarro-Pérez R, Aldecoa C, Montesinos-Fadrique S, Jover-Pinillos JL, Fernández-Valdés-Bango P, Abad-Gurumeta A, Jiménez-López I, García-Fernández J, Lorente JV

Author

Angel Vicente Espinosa MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Critical Care
Fluid Therapy
Hemodynamics
Humans
Microcirculation