Key result
Goal-directed therapy encompasses various conflicting strategies, such as oxygen delivery optimization and fluid restriction, requiring individualized approaches rather than universal application.
This commentary discusses the nuances of goal-directed therapy in perioperative and critical care settings, emphasizing the need for individualized, stroke volume-targeted fluid management combined with avoidance of crystalloid excess.
Goal-directed therapy (GDT) can be a vague term, meaning different things to different people and, depending on the clinical environment, sometimes even different things to the same person. It can refer to perioperative fluid management, clinicians driving oxygen delivery to supramaximal values, early treatment of sepsis in the emergency department, and even to restriction of perioperative crystalloids with the goal of maintaining preadmission body weight. Understandably, strong opinions about GDT vary; some clinicians consider it essential for perioperative care, others completely ineffective in critically ill patients. This commentary aims to further position the excellent review by Lees and colleagues in the context of the critical care and perioperative setting.
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Anthony Roche (2010) conducted an editorial in Sepsis and high-risk surgical patients. Goal-directed therapy (GDT) vs. Standard care was evaluated. Goal-directed therapy encompasses various conflicting strategies, such as oxygen delivery optimization and fluid restriction, requiring individualized approaches rather than universal application.
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