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Perioperative Goal-directed Therapy: Monitoring, Protocolized Care and Timing

  • M. Cecconi
  • C. Corredor
  • A. Rhodes
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)

Abstract

In the 1970s, Shoemaker observed that patients who survived high-risk surgical interventions had distinct hemodynamic patterns [1]. These included higher mean global oxygen delivery (DO2), cardiac index (CI) and tissue oxygen demand (VO2) than non-survivors. Shoemaker went on to develop the concept of perioperative optimization by using the survivors’ patterns as therapeutic goals [2]. Amongst survivors, consistent ‘supranormal’ oxygen flow physiological values were noted of DO2 > 600 ml/min/m2, VO2 > 170 ml/min/m2 and CI > 4.5 l/min/m2 [3]. Positive results in initial uncontrolled studies were corroborated by a controlled trial that used supranormal goals for hemodynamic optimization in the protocol group of high-risk surgical patients [4]. This protocol decreased mortality and spurred a wave of interest in perioperative goal directed therapy (GDT).

Keywords

Cardiac Output Cardiac Index Central Venous Oxygen Saturation Cardiac Output Monitoring Hemodynamic Optimization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • M. Cecconi
  • C. Corredor
  • A. Rhodes

There are no affiliations available

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