Goal-Directed Therapy in Cardiac Surgery: Are We There Yet?

GOAL-DIRECTED THERAPY (GDT) is the practice of using hemodynamic parameters, beyond standard ones such as heart rate and blood pressure, to optimize oxygen delivery. These parameters might include stroke volume (SV), cardiac output (CO), and central venous oxygen saturation (ScO2), or dynamic ones such as stroke volume variation or pulse pressure variation. Optimization of oxygen delivery using such parameters was described by Shoemaker in the 1980s. He observed that shock survivors had significantly higher cardiac index (CI), oxygen delivery (DO2), and oxygen consumption (VO2) than non-survivors. He then hypothesized that setting supranormal hemodynamic goals in high-risk surgical patients would compensate for increased perioperative metabolism, leading to decreased morbidity and mortality. His landmark study in 1988 showed significant reductions in mortality and hospital length of stay (LOS) in high-risk surgical patients managed with GDT. Other investigators have reported similar results, although the supranormal approach is still debated.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research