Goal-directed therapy using blood flow monitoring to achieve supranormal oxygen delivery targets in high-risk surgical patients decreases peri-operative morbidity and mortality.
Does goal-directed therapy improve outcomes in high-risk surgical patients?
Goal-directed therapy using fluids and inotropes to optimize hemodynamics can improve outcomes in high-risk surgical patients, though implementation remains challenging.
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.
Lees et al. (Thu,) conducted a review in High-risk surgical patients. Goal-directed therapy vs. Standard care was evaluated. Goal-directed therapy using blood flow monitoring to achieve supranormal oxygen delivery targets in high-risk surgical patients decreases peri-operative morbidity and mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: