tailieunhanh - Báo cáo y học: "Inotropes in goal-directed therapy: Do we need ‘goals’"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Inotropes in goal-directed therapy: Do we need ‘goals’ | Futier and Vallet Critical Care 2010 14 1001 http content 14 5 1001 CRITICAL CARE COMMENTARY L__ Inotropes in goal-directed therapy Do we need goals Emmanuel Futier1 and Benoit Vallet 2 See related research by Jhanji etal. http content 14 4 R151 Abstract There is substantial evidence to demonstrate the benefits of goal-directed hemodynamic optimization using fluid loading or inotropic support or both to improve outcome during major surgery. However until now only limited pathophysiological data have been available to explain this benefit. The maintenance of adequate tissue perfusion and global oxygen delivery is an essential goal for therapy. In an interesting study Jhanji and colleagues provided additional data that emphasize the roles of optimization of intravascular fluid status and low doses of inotropes to improve microvascular blood flow and tissue oxygenation. This commentary aims to highlight some issues raised by this important study and provides additional elements to further position these results. Adequate hemodynamic management using well-defined perioperative goal-directed therapy GDT is a cornerstone of tissue perfusion and oxygenation that can improve outcome. The aim of GDT is to prevent tissue oxygen debt and energy crisis by maintaining adequate tissue perfusion and oxygenation in relation to increased metabolic demand during major surgery. In an elegant study in the previous issue of Critical Care Jhanji and colleagues 1 highlighted the important pathophysiological mechanisms involved behind the benefit of GDT. The authors showed that stroke volume-targeted colloid administration coupled with a fixed infusion rate of dopexamine improved oxygen delivery DO2 central venous oxygen saturation ScvO2 micro-vascular blood flow and tissue oxygenation and that fluid Correspondence 2Department of Anaesthesiology and Critical Care Medicine CHU Lille University Nord de France Rue Polonovski 59037