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Goal-directed therapy in anesthesia: any clinical impact or just a fashion?
MedLine Citation:
PMID:  21540811     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Goal-directed therapy (GDT) describes the protocolized use of cardiac output and related parameters as end-points for fluid and/or inotropic therapy administration. Identifying the patient who will benefit from it has implications throughout perioperative management. The fundamental principle behind GDT is optimizing tissue perfusion by manipulating heart rate, stroke volume, hemoglobin and arterial oxygen saturation to improve oxygen delivery by using fluids, inotropes, red blood cells and supplementary oxygen. Although cardiac output and SvO2 were previously measured using the pulmonary artery catheter, a number of less invasive methods are now available. For intraoperative GDT, the esophageal Doppler-derived Flow Time correct (FTc) is the parameter used most frequently, although other parameters such as stroke volume obtained from Vigileo, PICCO and/or LiDCO, mixed and/or central venous oxygen saturation (SvO2/ScvO2), oxygen delivery and global end diastolic volume (PiCCO system) may be applied in daily clinical practice. The correct target to be followed during the intraoperative period must be clearly established. Most parameters depend primarily on O2 consumption and are not reliable or useful during anesthesia. To date, the quantity and the type of fluids to administer during major elective surgery remain an object of continuing debate. In conclusion, in terms of evidence-based medicine, GDT during anesthesia has a clinical impact when performed using an FTc-based fluids algorithm protocol. In contrast, GDT can be considered unreliable if confusing targets such as SvO2 or ScvO2 higher than 70% during anesthesia are followed.
Authors:
G Della Rocca; L Pompei
Publication Detail:
Type:  Journal Article     Date:  2011-03-01
Journal Detail:
Title:  Minerva anestesiologica     Volume:  77     ISSN:  1827-1596     ISO Abbreviation:  Minerva Anestesiol     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  545-53     Citation Subset:  IM    
Affiliation:
Department of Anesthesia and Intensive Care, Medical School of the University of Udine, Udine, Italy - livia.pompei@uniud.it.
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