Clinical review: What are the best hemodynamic targets for noncardiac surgical patients?

Abstract:

:Perioperative hemodynamic optimization, or goal-directed therapy (GDT), has been show to significantly decrease complications and risk of death in high-risk patients undergoing noncardiac surgery. An important aim of GDT is to prevent an imbalance between oxygen delivery and oxygen consumption in order to avoid the development of multiple organ dysfunction. The utilization of cardiac output monitoring in the perioperative period has been shown to improve outcomes if integrated into a GDT strategy. GDT guided by dynamic predictors of fluid responsiveness or functional hemodynamics with minimally invasive cardiac output monitoring is suitable for the majority of patients undergoing major surgery with expected significant volume shifts due to bleeding or other significant intravascular volume losses. For patients at higher risk of complications and death, such as those with advanced age and limited cardiorespiratory reserve, the addition of dobutamine or dopexamine to the treatment algorithm, to maximize oxygen delivery, is associated with better outcomes.

journal_name

Crit Care

authors

Lobo SM,de Oliveira NE

doi

10.1186/cc11861

subject

Has Abstract

pub_date

2013-03-19 00:00:00

pages

210

issue

2

eissn

1364-8535

issn

1466-609X

pii

cc11861

journal_volume

17

pub_type

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