Perioperative goal directed haemodynamic therapy – do it, bin it, or finally investigate it properly 英文参考文献.docVIP

Available online /content/11/5/170 Commentary Perioperative goal directed haemodynamic therapy – do it, bin it, or finally investigate it properly? Stephen Drage and Owen Boyd The General Intensive Care Unit, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK Corresponding author: Owen Boyd, owen.boyd@bsuh.nhs.uk Published: 26 October 2007 Critical Care 2007, 11:170 (doi:10.1186/cc6130) This article is online at /content/11/5/170 ? 2007 BioMed Central Ltd See related research by Lopes et al., /content/11/5/R100 Abstract and intensive care unit (ICU) stay. It is the dramatic outcome improvement that will be the talking point in this study and questions will be raised about the nature of treatment given to the control group – were they undertreated, what protocols were used for them and is this baseline mortality comparable to experience in my institution? On this last point it is noteworthy that other studies from South America have shown similar control outcomes [4]. The literature concerning the use of goal directed haemodynamic therapy (GDHT) in high risk surgical patients has been importantly increased by the study of Lopes and colleagues. Using a minimally invasive assessment of fluid status and pulse pressure variation monitoring during mechanical ventilation, improvements were seen in post-operative complications, duration of mechanical ventilation, and length of hospital and intensive care unit (ICU) stay. Many small studies have shown improved outcome using various GDHT techniques but widespread implementation has not occurred. Those caring for perioperative patients need to accept the published evidence base or undertake a larger, multi-centre study. Despite the quantity of evidence in support of the principle of GDHT, implementation has been patchy. There are a number of reasons for this including a lack of