Optimization of oxygen delivery during high-risk surgery keeping the concept but refining goals for inotrope infusion 英文参考文献.docVIP

Futier and Vallet Critical Care 2012,16:409 /content/16/1/409 LET TER Optimization of oxygen delivery during high-risk surgery: keeping the concept but re? ning goals for inotrope infusion? Emmanuel Futier* and Benoit Vallet 1 2 See related research by Lobo et al., /content/15/5/R226 We read with great interest the study by Lobo and to support the bene? t of maximizing DO while a better 2 colleagues [1] in a recent issue of Critical Care e outcome was obtained despite slightly lower levels of authors stated that ? uid restriction during optimization DO i (though the levels were not signi? cantly lower). 2 of oxygen delivery (DO ) using dobutamine improves One can therefore question the rationale of ‘maximi z a- 2 patient outcome after major surgery. Previous studies tion’ rather than use an individualized approach of tissue have shown that hemodynamic optimization using either an individualized goal-directed ? uid substitution or an O needs. 2 Adequacy of tissue oxygenation is de? ned by a DO2 inotrope to maximize DO reduces postoperative adapted to O demand [3]. However, the optimal value of 2 2 morbidity and hospital length of stay [2]. Although the DO to meet O needs is unknown because of its 2 2 relationship to metabolic demand and individual varia- tions of the critical DO erefore, we believe that it study by Lobo and colleagues sheds new light on the use of an inotrope during major surgery, we believe that the approach they support raises some unanswered questions. 2 is better to address the need for inotrope infusion given the VO -to-DO (oxygen consumption-to-oxygen delivery) 2 2 Our main concern is about using a speci? c target value relationship (that is, the