Minerva anestesiologica
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Minerva anestesiologica · May 2011
ReviewGoal-directed therapy in anesthesia: any clinical impact or just a fashion?
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. ⋯ 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.