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)


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).


Cardiac Output Cardiac Index Central Venous Oxygen Saturation Cardiac Output Monitoring Hemodynamic Optimization 
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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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