June 4, 2014

Hemodynamic Goal-Directed Therapy in High-Risk Surgical Patients

Author Affiliations
  • 1Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;311(21):2177-2178. doi:10.1001/jama.2014.5306

Most clinicians agree that during stress, such as acute critical illness or surgery, maintaining adequate perfusion and oxygen delivery reduces the risk of injury to vital organs. However, the best way to achieve these general goals remains controversial. A growing body of evidence suggests that “goal-directed therapy” (GDT) to increase blood flow can reduce postoperative complications and cost.1 Goal-directed therapy typically uses a monitoring tool to continuously assess cardiac performance, and through a set of protocolized instructions, fluid administration and vasoactive agents are titrated to optimize cardiac performance. A central tenet of many of these studies is that GDT should not be defined by the presence or absence of a monitoring device but rather by explicit goals of care, such as maintenance of sustained maximal stroke volume. In other words, a GDT protocol should clearly define how data from the monitor trigger specific changes in care.

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