Clinical review: Goal-directed therapy in high risk surgical patients

Nicholas Lees, Mark Hamilton, Andrew Rhodes, Nicholas Lees, Mark Hamilton, Andrew Rhodes

Abstract

A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri-operative period, the outcomes of these patients can be improved. This goal directed therapy includes the use of fluid loading and inotropes, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Despite the benefits seen, it remains a challenge to implement this management due to difficulties in identifying these patients, scepticism and lack of critical care resources.

Figures

Figure 1
Figure 1
Suggested algorithm for the provision of goal directed therapy to high risk surgical patients. ACC/AHA, American College of Cardiology/American Heart Association; CI, cardiac index; DO2I, oxygen delivery index.

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