Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy: grading recommendations in the era of evidence-based medicine, enhanced recovery after surgery programmes and precision medicine. Comment on Br J Anaesth 2025; 135: 547–60

We read the with interest Perioperative Quality Initiative (POQ)I-11 consensus statement on perioperative goal-directed haemodynamic therapy (GDHT), and thank the authors for addressing a complex and clinically important area of perioperative care.1 GDHT remains a valuable strategy to optimise tissue perfusion by guiding fluids, vasopressors, and inotropes to physiological targets; prior randomised trials and meta-analyses have suggested reductions in postoperative complications in selected settings.2–5 At the same time, recent large pragmatic effectiveness trials and evolving perioperative pathways, such as enhanced recovery after surgery (ERAS), complicate the interpretation of where and how GDHT should be applied.6,7 We highlight four points intended to sharpen clinical interpretation and help prioritise future research on the subject: (1) methodological transparency in producing consensus recommendations; (2) careful interpretation of large pragmatic trials and the limits of generalisability of specific implementations; (3) ERAS interaction and the ERAS literature; and (4) a forward-looking research and reporting agenda that tests individualised GDHT within contemporary ERAS pathways and with technology-assisted delivery.