Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2019 Apr-Jun;9(2):54-56.
doi: 10.4103/IJCIIS.IJCIIS_38_19.

Hemodynamic early goal-directed therapy: Explaining the fine print

Zoe Goldthwaite  1 , Michael S Firstenberg  1 , Alex Botsch  2
Affiliations
Editorial

Hemodynamic early goal-directed therapy: Explaining the fine print

Zoe Goldthwaite et al. Int J Crit Illn Inj Sci. 2019 Apr-Jun.

Abstract

The management of patients after cardiothoracic surgery can be very complex. Variabilities exist in hemodynamic status after cardiac surgery and the use of cardiopulmonary bypass - all of which can have a significant impact on myocardial Frank-Starling curves. Typically, invasive monitoring with pulmonary artery catheters is used to assess the complex physiology that these patients experience in the perioperative setting. However, the use of invasive monitoring is not without risk, and the broader benefits are poorly defined. Furthermore, there is growing evidence to support the use of hemodynamic early goal-directed therapy to optimize outcomes in critically ill patients. The purpose of this editorial statement is the review of some of the current literature with regards to the utility of goal-directed therapy as applied to the postoperative cardiac surgical patient.

Keywords: Cardiac surgery; enhanced recovery; goal-directed therapy; pulmonary artery catheter.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

References

    1. Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995;130:423–9. - PubMed
    1. Engelman DT, Boyle EM, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. ERAS Cardiac Surgery: Enhanced Recovery After Cardiac Surgery Society. San Diego: American Association for Thoracic Surgery; 2018.
    1. Saugel B, Michard F, Scheeren TW. Goal-directed therapy: Hit early and personalize! J Clin Monit Comput. 2018;32:375–7. - PubMed
    1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77. - PubMed
    1. Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–11. - PubMed

Publication types