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Review
. 2013 Mar 19;17(2):210.
doi: 10.1186/cc11861.

Clinical review: What are the best hemodynamic targets for noncardiac surgical patients?

Suzana Margareth Lobo, Neymar Elias de Oliveira
Review

Clinical review: What are the best hemodynamic targets for noncardiac surgical patients?

Suzana Margareth Lobo et al. Crit Care. .

Abstract

Perioperative hemodynamic optimization, or goal-directed therapy (GDT), has been show to significantly decrease complications and risk of death in high-risk patients undergoing noncardiac surgery. An important aim of GDT is to prevent an imbalance between oxygen delivery and oxygen consumption in order to avoid the development of multiple organ dysfunction. The utilization of cardiac output monitoring in the perioperative period has been shown to improve outcomes if integrated into a GDT strategy. GDT guided by dynamic predictors of fluid responsiveness or functional hemodynamics with minimally invasive cardiac output monitoring is suitable for the majority of patients undergoing major surgery with expected significant volume shifts due to bleeding or other significant intravascular volume losses. For patients at higher risk of complications and death, such as those with advanced age and limited cardiorespiratory reserve, the addition of dobutamine or dopexamine to the treatment algorithm, to maximize oxygen delivery, is associated with better outcomes.

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Figures

Figure 1
Figure 1
Algorithm for peroperative hemodynamic optimization in patients undergoing major surgeries. DO2, oxygen delivery.
Figure 2
Figure 2
Algorithm for peroperative hemodynamic optimization in high-risk patients undergoing major surgeries. Shoemakers' criteria from [35]. DO2, oxygen delivery; GDT, goal-directed therapy.
See this image and copyright information in PMC

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