tailieunhanh - Báo cáo y học: "Clinical review: Goal-directed therapy in high risk surgical patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Goal-directed therapy in high risk surgical patients. | Available online http content 13 5 231 Review Clinical review Goal-directed therapy in high risk surgical patients Nicholas Lees Mark Hamilton and Andrew Rhodes Department of Intensive Care Medicine St George s Healthcare NHS Trust Blackshaw Road London SW17 0QT UK Corresponding author Andrew Rhodes andyr@ Published 26 October 2009 This article is online at http content 13 5 231 2009 BioMed Central Ltd Critical Care 2009 13 231 doi cc8039 Abstract A small group of patients account for the majority of peri-operative morbidity and mortality. These high-risk patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri-operative period the outcomes of these patients can be improved. This goal directed therapy includes the use of fluid loading and inotropes in order to optimize the preload contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Despite the benefits seen it remains a challenge to implement this management due to difficulties in identifying these patients scepticism and lack of critical care resources. Oxygen delivery and hypoxia Oxygen is the substrate mitochondria require for aerobic metabolism. As oxygen is not stored a constant supply is required. One of the main functions of the cardiovascular system is in part to supply tissues with oxygen. This supply must match any changing metabolic demands otherwise inflammation and organ dysfunction may occur. Global oxygen delivery DO2 is the total amount of oxygen delivered to tissues per minute and is described by the equation DO2 ml minute Cardiac output CO L minute X arterial oxygen content CaO2 At rest and in health DO2 exceeds the oxygen consumption of all tissues VO2 combined. The oxygen .